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A decisional diagram for the management of thymomas based on a Tunisian multidisciplinary team′s experience and a review of the literature

Background: Thymomas are rare tumors with a challenging management. After a review of the literature, we noticed the absence of a simplified decisional diagram. We aimed to present a scheme for the management of these tumors based on the experience of a Tunisian multi-disciplinary team and a review of the literature. Patients and Methods: We report a retrospective study 100 thymomas diagnosed between 1994 and 2011. We also performed an exhaustive PubMed research using the keywords: Thymoma, prognosis, management. We noticed, that the most famous studies were reported in the 1990s with most of them being a review of the literature. Results: The proposed decisional diagram is quite similar to the National Comprehensive Cancer Network (NCCN) guidelines with some particularities. These particularities consist in the recommendation of an initial surgical resection even in advances disease (stages IIIb or IVa) and the association of a radiation therapy in R1 or R2 stages I, II, and IIIa thymomas. Conclusion: This study highlights the necessity of further research performed in the field of thymoma in order to answer the unresolved question. This work seems to be necessary and helpful in daily practice of thoracic surgeons and clinicians.