The radiotherapeutic management of invasive thymomas

The role of radiation therapy has been well established for selected patients with thymoma. Among patients with stage I tumors that have undergone a complete surgical excision, there is no indication for postoperative RT. There is also no need for postoperative RT for patients with completely excised stage II tumors when there is no transgression of the tumor through the thymic capsule. If there is transgression of the tumor through the capsule, postoperative RT is recommended even in the presence of complete surgical resection. For totally or partially resected stage III tumors, postoperative RT, to a total dose in excess of 50.4 Gy, is recommended. CT scan-based treatment planning is recommended for all of these indications. The role of preoperative RT is currently less certain. For bulky, unresectable tumors, preoperative chemotherapy and postoperative RT seem to be a promising trimodality approach. There also will be a need for preoperative RT among partial responders.