Optimal management of thymic malignancies: current perspectives

Figures & data

Table 1 Masaoka-Koga staging

Masaoka-Koga staging
Stage I		Grossly and microscopiolly anopsulated
Stage II	a	Microscopic transcapsular invasion
	b	Macroscopic capsular invasion
Stage III		Macroscoping invasion of neighboring organs, incuding pedal rdium, lung, or the main blood vessels
Stage IV	a	Pleural or periardial dissemination
	b	Hematogenous or lymphatic dssemination

Table 2 The IASLC/ITMIG thymic epithelial tumors staging

Category			Definition
T	T1	a	Encapsultated or not with or without extension into mediastinal fat
		b	Extension into mediastinal pleura
	T2		Pericardium
	T3		Lung, brachiocephalic vein, superior vena cava, chest wall, phrenic nerve Hilar (extrapericardial) pulmonary vessels
	T4		Aorta, arch vessels, main pulmonary artery, myocardium, trachea, or oesophagus
N	N0		No nodal involvrnent
	N1		Anterior (perithymic nodes
	N2		Deep intra thoracic or cervical nodes
M	M0		No metastatic pleural, pericardial or distant sites
	M1	a	Separate pleural or pericardial nodule(s)
		b	Pulmonary intraparenchymal nodule or distant organ metastasis

Table 3 Stage grouping according to the IASLC/ITMIG thymic epithelial tumors staging

Stage	T	N	M
I	T1	N0	M0
II	T2	N0	M0
IIIa	T3	N0	M0
IIIb	T4	N0	M0
IVa	T any	N1	M0
	T any	N0, N1	M1a
IVb	T any	N2	M0, 1a
	T any	N any	M1b

Figure 1 HES (Hematoxillin-Eosin-Safran) colorations of different subsets of thymic epithelial tumors, classified according to the World Health Organization classification.

Figure 2 RYTHMIC recommendation for resectable thymic tumors from the RYTHMIC network, TNM I–II, Masaoka-Koga I–III.

Figure 3 RYTHMIC recommendation for initially unresectable thymic tumors from the RYTHMIC network, TNM IIIa–IIIb and IVa, Masaoka-Koga III–IVa.

Figure 4 RYTHMIC recommendation for metastatic disease TNM IVb and Masaoka-Koga IVb.

Figure 5 Operating views of thymic surgery: (A) enlarged thymectomy for B2 thymoma, the black arrow indicates the tumor developed in the left side of the thymus with mediastinal pleural involvement. (B) Right pleura after cytoreductive pleural surgery during ITCH procedure. The white arrow indicates pleural node of a A thymoma R₀ resected two years before.

Figure 6 Chemotherapy and other treatments delivered in patients prospectively included in the French RYTHMIC registry.

Abbreviations: CAP, Cyclophosphamid-Adriblastin-Cisplatin; TKI, Tyrosin Kinase Inhibitors.