AccScience Publishing / ARNM / Online First / DOI: 10.36922/ARNM025360043
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ORIGINAL RESEARCH ARTICLE

Real-world outcomes of radiation therapy-based multimodal therapy in thymic epithelial tumors: A single-center retrospective analysis

Sorun Shishak1 ,  Tejinder Kataria1 ,  Subham Pal1 ,  Susovan Banerjee1 ,  Deepak Gupta1 ,  Kushal Narang1 ,  Mayur Mayank1 ,  Shikha Goyal2 ,  Shina Goyal3 ,  Sameer Rastogi4 ,  Bosky Jain5 ,  Sasmita Priyadarshini Sahoo6 ,  Gargi Sharma1 ,  Sabyasachi Sarkar1 ,  Shyam Singh Bisht1*
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1 Division of Radiation Oncology, Medanta The Medicity, Gurugram, Haryana, India
2 Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Medical Oncology, Max Super Specialty Hospital, Dwarka, New Delhi, India
4 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
5 Department of Radiology, Medanta The Medicity, Gurugram, Haryana, India
6 Department of Radiation Oncology, Bagchi Sri Shankara Cancer Centre and Research Institute, Bhubaneswar, Odisha, India
ARNM, 025360043 https://doi.org/10.36922/ARNM025360043
Received: 1 September 2025 | Revised: 25 November 2025 | Accepted: 19 December 2025 | Published online: 11 February 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Thymic epithelial tumors (TETs) are rare malignancies with diverse histologic subtypes and complex clinical behavior, necessitating a multidisciplinary approach to care. We conducted a retrospective analysis of 52 patients with TETs treated at a tertiary cancer center, including 41 with thymoma and 11 with thymic carcinoma. The median age was 50 years for thymoma and 56 years for thymic carcinoma. Paraneoplastic syndromes, particularly myasthenia gravis, were more frequent in thymoma (46.3%) than in thymic carcinoma (9.1%). Most patients presented with advanced-stage disease (stage IIIA or higher accounted for 75.7% of thymoma cases and 72.8% of thymic carcinoma cases). Neoadjuvant chemotherapy was administered to 26.8% of thymoma cases and 27.3% of thymic carcinoma cases. Surgical resection was performed in 90.2% of thymoma and 63.6% of thymic carcinoma patients, with complete resection (R0) achieved in 83.8% and 71.4%, respectively. Post-operative radiotherapy (RT) was widely utilized, delivered via volumetric-modulated arc therapy or tomotherapy. Four patients with stage IVA thymoma received hyperthermic intrathoracic chemotherapy after cytoreductive surgery. At a median follow-up of 6 years, the 5-year overall survival for thymoma and thymic carcinoma was 70.0% and 30.7%, respectively, while the 5-year progression-free survival for thymoma and thymic carcinoma was 85.1% and 26%, respectively. Relapse occurred in 17.1% of thymoma and 63.6% of thymic carcinoma patients. Despite the predominance of advanced-stage disease and large tumor burden at presentation, an aggressive, multimodal treatment approach—including high rates of R0 resection, advanced RT techniques (e.g., volumetric modulated arc therapy, tomotherapy), multiline systemic therapy, and selective hyperthermic intrathoracic chemotherapy—demonstrates potential to improve treatment outcomes. Recurrence is the strongest predictor of mortality in both thymoma and thymic carcinoma.

Keywords
Thymoma
Thymic carcinoma
Thymic epithelial tumors
Myasthenia gravis
Multidisciplinary
Radiation
Post-operative radiotherapy
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Advances in Radiotherapy & Nuclear Medicine, Electronic ISSN: 2972-4392 Print ISSN: 3060-8554, Published by AccScience Publishing
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