Misc Thoracic

Question 1

What is the Masaoka staging system for thymoma?

Answer 1

• Stage I
  – Macroscopically encapsulated and no microscopic capsular invasion
• Stage II
  – Ila: microscopic invasion into the capsule
  – Ilb: macroscopic invasion into surrounding fatty tissue or grossly adherent to but not breaking through the mediastinal pleura or pericardium
• Stage Ill: macroscopic invasion into neighboring structures, i.e., mediastinum, pericardium, great vessels, or lung as well as invasion into the mediastinal pleura
• Stage IVa: pleural or pericardial implants
• Stage IVb: lymphatic or hematogenous metastasis

Question 2

What is an Askin tumor?

Answer 2

Ewing sarcoma of the CS

Question 3

Is a bx required for all cases of thymoma?

Answer 3

• No
• Surgically-resectable, well-defined anterior mediastinal masses w/o adenopathy and negative serum tumor markers (representing high clinical suspicion of thymic malignancy) may proceed directly to surgical resection without a biopsy

Question 4

What RT doses are recommended for a thymoma?

Answer 4

• Unresectable: 60-70 Gy
• PORT
  – R0 resection: 45-50 Gy
  – R1 resection: 54 Gy
  – Gross residual disease: 60-70 Gy

Question 5

What are the most common histologies for primary tracheal carcinomas?

Answer 5

• SqCC and Adenoid Cystic Carcinoma (ACC)
  – SqCC: 45%
  – Older pts (6th decade of life)
  – Occur in the distal 1/3rd of the trachea
  – Multifocal w/ areas of metaplasia and CIS
  – ACC: 16%
  – Younger pts
  – Located in the proximal trachea
  – Slow-growing, indolent

Question 6

What is removed during an extrapleural pneumonectomy for malignant mesothelioma?

Answer 6

• Affected Lung
• Pleura
• Hemi-diaphragm
• Ipsilateral pericardium

Question 7

What is the hemithoracic radiation technique for malignant mesothelioma?

Answer 7

• Total Dose: 54 Gy
  – Can consider boosting gross disease to 60 Gy
• The stomach or liver is blocked
  – An e^- field patch is used to supplement the pleural space under the block
• Heart is blocked at 19.8 Gy to prevent pericarditis
• Spinal cord is blocked after 41.4 Gy (the medial
  border is moved to the ipsilateral border of the vertebral bodies)

Question 8

What are the standard CHT for thoracic malignancies?

Answer 8

• NSCLC
  – Carboplatin and paclitaxel
  – Cisplatin and etoposide
• SCLC
  – Cisplatin and etoposide
• Mesothelioma
  – Cisplatin and pemetrexed
  – + Bevacizumab, if unresectable
• Thymoma
  – Cisplatin, doxorubicin, and cyclophosphamide
• Thymic carcinoma
  – Cyclophosphamide, adriamycin, cisplatin, prednisone (CAPP)

Question 9

What CHT is first-line for unresectable mesothelioma and how is it given?

Answer 9

• Cisplatin 75 mg/m² and Pemetrexed 500 mg/m² q3 weeks
• • Bevacizumab for unresectable (NCCN Category 1 rec.)