Follow-up/Toxicity

Question 1

Per NCCN 2018, what is the f/u for pts who have had a complete resection of a thymoma and thymic carcinoma?

Answer 1

F/u includes H&P + CT chest every 6 mos × 2 yrs f/b annual CT scans.

Question 2

Is 5 yrs of f/u sufficient for a pt treated for thymomas?

Answer 2

No. Late recurrences can occur at >10 yrs. Pts need lifelong f/u.

Question 3

What are the expected early and late toxicities after adj RT for the management of thymic tumors?

Answer 3

Early: skin reaction, fatigue, dysphagia/odynophagia, cough

Late: RT pneumonitis/fibrosis, pericarditis, esophageal stricture, myelitis

Question 4

What are the dose-limiting structures and dose limits when the ME is irradiated?

Answer 4

Lung: RT alone → V20 <40%; CRT → V20 <35%, V5 <65%, MLD <20 Gy

Heart: V40 <50% (V40 <40% if CRT)

SC: ≤45 Gy

Esophagus: Ideally, the mean dose of RT to the esophagus should be <34 Gy. Try to minimize the V60 as much as possible (V60 <33%, V50 <50%, ≤45 Gy to the entire esophagus, max dose point <70 Gy).