Analysis of efficacy and safety of intensity-modulated radiotherapy with “Target-Ring” strategy for stage IVA large-volume thymoma and thymic carcinoma: a single-center study
Dongshu Chang#
, Zhiguang Fu#
, Jing Li, Yupeng Di, Xuan Wang, Haifeng Pang, Yong Wang, Yingjie Wang
Contributions: (I) Conception and design: D Chang; (II) Administrative support: Yingjie Wang; (III) Provision of study materials or patients: J Li, Y Di, X Wang, H Pang, Yong Wang; (IV) Collection and assembly of data: Z Fu; (V) Data analysis and interpretation: Z Fu; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
#These authors contributed equally to this work.
Background: Thymic tumors at stage IVA are characterized by local invasion into adjacent structures (e.g., pericardium, great vessels) and/or regional lymph node metastasis, with unresectable large-volume tumors posing unique therapeutic challenges due to their proximity to critical thoracic organs and potential for high tumor burden. Additionally, previous studies have shown that conventional radiotherapy for advanced thymic malignancies may be limited by dose constraints to normal tissues, highlighting the need to assess the role of intensity-modulated radiotherapy (IMRT) in optimizing therapeutic ratios. This study aimed to evaluate the efficacy and safety of IMRT in treating unresectable large-volume thymic tumors at stage IVA.
Methods: A retrospective analysis was conducted on 13 patients with unresectable large-volume stage IVA thymic tumors treated between January 2010 and June 2018. All patients received radical IMRT using the “Target-Ring” dose escalation strategy, with prescribed doses of 50 Gy to the planning target volume (PTV), 60 Gy to the clinical target volume (CTV), and 70 Gy to the gross tumor volume (GTV) delivered in 15–20 fractions. Outcomes including objective response rate (ORR), disease control rate (DCR), local progression-free survival (LPFS), overall survival (OS), and adverse reactions were analyzed.
Results: The median follow-up was 82 months (range, 13–145 months). The ORR was 84.6% (11/13), and the DCR was 100% (13/13). The 1-, 3-, 5-, and 8-year OS rates were 100%, 69.2%, 61.5%, and 39.6%, respectively, while the corresponding LPFS rates were 100%, 69.2%, 59.3%, and 37.1%. Only one patient experienced grade 3 hematologic toxicity; no grade ≥3 non-hematologic toxicities were observed. Seven patients died of cancer-related progression.
Conclusions: IMRT with the “Target-Ring” strategy demonstrates favorable efficacy and safety for unresectable large-volume stage IVA thymic tumors, offering a viable non-surgical treatment option.
Keywords: IVA thymic tumors; intensity-modulated radiotherapy (IMRT); large volume; “Target-Ring” dose incremental mode
Submitted May 03, 2025. Accepted for publication Jul 18, 2025. Published online Oct 29, 2025.
doi: 10.21037/jtd-2025-888
Highlight box
Key findings
• Intensity-modulated radiotherapy (IMRT) with the “Target-Ring” strategy achieved an 84.6% objective response rate and 100% disease control rate in unresectable large-volume stage IVA thymic tumors.
• Median follow-up of 82 months showed 5-year overall survival and local progression-free survival rates of 61.5% and 59.3%, respectively.
• Safety was favorable, with only 1 case of grade 3 hematologic toxicity and no grade ≥3 non-hematologic adverse reactions.
What is known and what is new?
• IMRT is used for unresectable thymic tumors, but data on large-volume stage IVA cases are scarce.
• This study shows “Target-Ring” dose escalation (50–70 Gy in 15–20 fractions) safely improves local control and survival in this subgroup.
What is the implication, and what should change now?
• IMRT with this strategy is a viable non-surgical option for advanced thymic tumors.
• Clinical guidelines may consider recommending this approach, pending validation in multicenter trials.
Introduction
Thymic tumors are the most common primary neoplasms of the anterior mediastinum. The reported incidence varies regionally: 0.13 per 100,000 in the United States (1), 0.17 per 100,000 in Europe (2), and 0.39 per 100,000 in China (3). Approximately one-third of cases present with locally advanced or metastatic disease. For unresectable tumors, multimodal approaches incorporating radiotherapy, chemotherapy, and immunotherapy are recommended. Advances in radiotherapy, particularly image-guided intensity-modulated radiotherapy (IMRT), have replaced traditional three-dimensional (3D) conformal techniques due to superior dose conformity and organ-at-risk (OAR) sparing (4-7). This study retrospectively evaluates the outcomes of IMRT using a “Target-Ring” dose escalation strategy for unresectable large-volume (≥200 cm3) stage IVA thymic tumors. We present this article in accordance with the STROBE reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-888/rc).
Methods
Study design
This was a retrospective study. The aim was to evaluate the efficacy and safety of IMRT in patients with IVA-stage thymic tumors with a large volume (≥200 cm3) and inoperable status. We retrospectively collected and analyzed the medical records and treatment-related data of these patients to observe the treatment outcomes.
Setting
The study was conducted in the Air Force Medical Center, Beijing, China. Patient recruitment started from January 2010, and the follow up ended in December 2024. The exposure to radiotherapy occurred during the treatment period for each patient within this overall time frame.
Participants
Patients were included if they had pathologically confirmed IVA-stage thymic tumors with a volume of ≥200 cm3 and were assessed as inoperable by preoperative imaging. Patients were selected from the hospital’s oncology department database. A total of 13 patients met the criteria, including 7 male and 6 female patients, aged 31–83 years (median age: 55 years). Among them, 2 patients were found to be unresectable during surgery and only underwent biopsy. The pathological types included B1 thymoma (n=2), B2 (n=2), B3 (n=3), mixed B3 and C (n=2), and C type thymic carcinoma (n=4). Two patients presented with superior vena cava syndrome, 4 had pericardial effusion, 4 had pleural effusion, 9 had respiratory symptoms, and 2 had myasthenia gravis (1 with blepharoptosis and 1 with weakness of both lower limbs). Follow-up was carried out through regular outpatient visits and telephone interviews. The follow-up frequency was once every 3 months during the first year after radiotherapy, and then once every 6 months (Table 1).
Table 1
| Characteristic | Value |
|---|---|
| Gender | |
| Male | 7 |
| Female | 6 |
| Age at treatment, years | 55 (31–83) |
| Smoking | |
| Yes | 4 |
| No | 9 |
| ECOG score | |
| 0 | 7 |
| 1 | 6 |
| Pathological type | |
| B1 | 2 |
| B2 | 2 |
| B3 | 3 |
| B3+C | 2 |
| C | 4 |
| Radiotherapy technology | |
| Intensity modulated radiation therapy | 3 |
| Volumetric-modulated arc therapy | 2 |
| TomoTherapy | 8 |
| Tumor volume (GTV) | |
| ≥300 cm3 | 9 |
| 200–<300 cm3 | 4 |
| Clinical symptoms | |
| Superior vena cava syndrome | 2 |
| Pericardial effusion | 4 |
| Pleural effusion | 4 |
| Respiratory symptoms | 9 |
| Myasthenia gravis | 2 |
Data are presented as n or median (range). ECOG, Eastern Cooperative Oncology Group; GTV, gross tumor volume.
Variables
Outcomes were evaluated according to the RECIST 1.1 criteria, including complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Acute and late adverse reactions were evaluated according to the radiation injury grading standard of the Radiation Therapy Oncology Group (RTOG). The specific radiotherapy regimen, including the type of radiotherapy (3 patients with IMRT, 2 with volumetric-modulated arc therapy, 8 with TomoTherapy), dose prescription [using the “Target-Ring” dose-incremental mode, planning target volume (PTV) dose 50 Gy, clinical target volume (CTV) dose 60 Gy, gross tumor volume (GTV) dose 70 Gy, frequency 15–20], and treatment devices [Elekta Synergy (Stockholm, Sweden) and Accuray TomoTherapy (Madison, Wisconsin, USA)]. Age, gender, and pathological type were considered as potential confounders. Age was categorized into <60 years and ≥60 years; gender was divided into male and female; and pathological types were grouped as described above.
Data sources/measurement
Patient demographic data, clinical manifestations, and pathological information were obtained from the hospital’s medical record system. Radiotherapy-related data, such as treatment plans and verification results, were retrieved from the Elekta Monaco treatment planning system, Accuray Helical TomoTherapy Planning Station, and the daily cone beam computed tomography (CBCT) or megavoltage computed tomography (MVCT) verification records. For patient characteristics, information was collected through chart review. For radiotherapy parameters, the Elekta Monaco and Accuray Helical TomoTherapy systems were used to accurately measure and record dose-volume parameters for organs at risk and target volumes. The daily CBCT or MVCT was used to verify the accuracy of the treatment position (Table 2).
Table 2
| Characteristic | Minimum value | Maximum value | Average value | Standard deviation |
|---|---|---|---|---|
| All-lung average dose (Gy) | 6.41 | 17.72 | 13.14 | 3.39 |
| All-lung V5 (%) | 29.93 | 84.09 | 60.99 | 14.36 |
| All-lung V20 (%) | 10.15 | 32.69 | 22.46 | 7.10 |
| All-lung V30 (%) | 4.68 | 19.00 | 12.41 | 5.17 |
| Esophagus max dose (Gy) | 29.91 | 71.35 | 46.99 | 12.82 |
| Esophagus average dose (Gy) | 11.98 | 35.31 | 18.88 | 6.99 |
| Esophagus V40 (%) | 0 | 50.00 | 7.69 | 15.02 |
| Esophagus V50 (%) | 0 | 41.00 | 4.68 | 12.11 |
| Heart max dose (Gy) | 3.26 | 76.39 | 57.09 | 18.08 |
| Heart average dose (Gy) | 1.02 | 26.45 | 10.58 | 7.43 |
| Heart V30 (%) | 0 | 32.53 | 9.83 | 10.17 |
| Heart V40 (%) | 0 | 17.90 | 4.91 | 6.14 |
| Spinal cord max dose (Gy) | 11.53 | 44.85 | 25.46 | 10.37 |
Bias
To minimize selection bias, all eligible patients within the specified time period in the hospital’s database were included in the study. To reduce information bias, the medical record review was conducted by two experienced oncologists independently, and any discrepancies were resolved through discussion. For confounding bias, potential confounders such as age, gender, and pathological type were adjusted for in the statistical analysis.
Study size
The sample size of 13 patients was determined based on the availability of patients who met the inclusion criteria during the study period. A power analysis was not conducted due to the limited number of eligible patients in this single-center study. However, considering the rarity of this type of advanced thymic tumor, this sample size was considered sufficient to provide preliminary insights into the treatment outcomes.
Quantitative variables
Quantitative variables, such as age, were analyzed as continuous variables in the univariate analysis. In the multivariate analysis, age was dichotomized into <60 years and ≥60 years to simplify the model and better illustrate its relationship with the treatment outcomes. Other quantitative variables related to radiotherapy, such as dose and fractionation, were analyzed according to their specific values in the context of treatment planning and outcome evaluation.
Statistical analysis
SPSS 27.0 statistical software was used for analysis. Kaplan-Meier method was used to calculate the overall survival (OS) rate. Log-rank univariate analysis was performed, with P<0.05 considered statistically significant.
Ethical statement
This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethics Committee of Air Force Medical Center (No. 2025-90-PJ01). Informed consent was waived due to the use of anonymized, non-identifiable data.
Results
Clinical symptoms
Two patients experienced relief from facial swelling caused by superior vena cava syndrome. Nine patients’ respiratory symptoms were relieved to varying degrees. One patient’s ptosis improved, and one patient’s weakness in both lower limbs was relieved.
Efficacy analysis
Until December 2024, the follow-up rate reached 100%, median follow-up of 82 months (13–145 months). In this study, the objective response rate (ORR) was defined as the objective imaging evaluation of measurable solid tumors within six months to one year after radiotherapy. Among all 13 patients, 11 patients were evaluated as PR, and 2 patients were evaluated as SD. Therefore, the ORR was 84.6% (11/13). The disease control rate (DCR) could reach 100% (13/13). It is worth noting that when calculating the ORR, except for 2 patients who had received systemic treatment before enrollment (progressed after chemotherapy, and the stage was IVA after progression), the remaining patients had not received systemic treatment before radiotherapy. The disease-free survival (DFS) in this study was defined as the time from the end of radiotherapy to the first occurrence of local recurrence. During the follow-up period, the median DFS was calculated to be 62 months. The median OS time was 82 months. The 1-, 3-, 5-, and 8-year OS rates were 100%, 69.2%, 61.5%, and 39.6%, respectively. The 1-, 3-, 5-, and 8-year local progression-free survival (LPFS) rates were 100%, 69.2%, 59.3%, and 37.1%, respectively. Ten patients developed metastasis and all received chemotherapy. Among them, 7 patients had distant pleural metastasis, 3 patients received re-radiotherapy, 1 patient had lung metastasis, 1 patient had liver metastasis and received radiotherapy, and 1 patient had liver and lung metastasis at the same time. Seven patients died due to tumor metastasis and progression.
Adverse reactions
All patients completed the treatment as planned. Except for 1 patient with grade 3 hematological acute adverse reactions, no grade 3 or higher adverse reactions were observed in the rest. In the acute adverse reactions within three months, hematological adverse reactions occurred in 5 patients (38.5%), radiation esophageal injury occurred in 4 patients (30.8%), radiation skin injury occurred in 1 patient (7.7%), and radiation lung injury occurred in 3 patients (23.1%). In the late adverse reactions after 3 months, 7 patients had radiation-induced lung injury (53.8%), 2 patients had grade 2 radiation-induced lung injury (15.4%), 1 patient had radiation-induced esophageal injury (7.7%), 1 patient had radiation-induced skin injury (7.7%), 3 patients had cardiotoxicity (23.1%), 2 patients had grade 2 cardiotoxicity (15.4%), 1 patient developed elevated blood pressure three years after treatment, and 1 patient experienced palpitations five years after treatment. All adverse reactions were alleviated after symptomatic treatment (Table 3).
Table 3
| Adverse reactions | Grade 1 | Grade 2 | Grade 3 | Grade 4–5 |
|---|---|---|---|---|
| Acute adverse reactions | ||||
| Hematologic | 3 | 1 | 1 | 0 |
| Respiratory | 3 | 0 | 0 | 0 |
| Circulatory | 0 | 0 | 0 | 0 |
| Digestive | 3 | 1 | 0 | 0 |
| Skin | 1 | 0 | 0 | 0 |
| Later adverse reactions | ||||
| Respiratory | 5 | 2 | 0 | 0 |
| Circulatory | 1 | 2 | 0 | 0 |
| Digestive | 1 | 0 | 0 | 0 |
| Skin | 1 | 0 | 0 | 0 |
Analysis of prognostic factors
Univariate analysis of prognostic factors that may affect patients, such as gender, Eastern Cooperative Oncology Group (ECOG) score, smoking, pathological classification, tumor volume, and radiotherapy technology, showed no statistically significant difference (P value >0.05).
Discussion
The overarching objective of this study was to assess the efficacy and safety of IMRT in the management of unresectable stage IVA large-volume thymic tumors. Thymic tumors, encompassing thymoma and thymic carcinoma, are classified as thymic epithelial tumors according to the World Health Organization (WHO) histological classification, with an incidence rate ranging from 1.3 to 3.2 per million individuals (8). For early and mid-stage thymic tumors, complete surgical resection is the gold-standard treatment modality, with the completeness of resection being the most critical prognostic factor (9).
In the present study, all patients were administered radical IMRT, with the “Target-Ring” dose-incremental mode implemented. The biologically effective doses in the peritumoral region (62.5–66 Gy) and within the tumor itself (94.5–102.7 Gy) were substantially higher than those of conventional radiotherapy (60 Gy, 50 Gy, 25 fractions). The ORR was 84.6%. The 1-, 3-, 5-, and 8-year OS rates were 100%, 69.2%, 61.5%, and 39.6%, respectively, while the corresponding 1-, 3-, 5-, and 8-year LPFS rates were 100%, 69.2%, 59.3%, and 37.1%.
Notably, 2 patients presenting with superior vena cava syndrome experienced alleviation of symptoms during radiotherapy, and 9 patients with respiratory symptoms demonstrated varying degrees of improvement. For patients who developed new metastases, subsequent adjuvant chemotherapy was administered.
The study cohort consisted of only 13 patients, a relatively small number that may impede the accurate discrimination of the impact of various factors on prognosis, such as tumor size. When comparing patients with tumor volumes ≥300 cm3 to those with volumes between 200 and 300 cm3, no statistically significant difference in the P value was observed; however, the limited sample size precluded a more comprehensive analysis.
The retrospective selection of patients from a single-center database poses a risk of selection bias. It is plausible that certain patient characteristics or case types were either over- or under-represented, potentially compromising the generalizability of the study results.
For patients with thymic carcinoma, even with complete resection, the 5-year survival rate remained relatively low (10,11). Considering the study’s objectives, limitations, findings from analogous studies, and other pertinent evidence, the results of this study suggest that IMRT can serve as an effective and safe treatment option for patients with unresectable stage IVA large-volume thymic tumors. In comparison with previous research, Vogel et al. (12) utilized proton therapy for thymic tumor treatment, reporting good patient tolerance and satisfactory therapeutic outcomes. Proton and heavy-ion radiotherapy have been shown to offer excellent protection of organs at risk and target conformity (13). The 2022 National Comprehensive Cancer Network (NCCN) Guidelines recognized the dosimetric advantages of proton therapy; however, the translation of these advantages into clinical benefits remains unsupported by evidence-based medical data. In most solid tumors, tumor size is a pivotal prognostic factor. Studies by Bian et al. (14), Safieddine et al. (15), and Fukui et al. (16) have established a correlation between tumor size, tumor staging, and prognosis, indicating a negative association between tumor size and prognosis. Although the sample size in this study precluded a clear delineation of the impact of tumor size on prognosis, the successful application of radical radiotherapy for large-volume tumors underscores an advancement in medical technology. For stage IVA thymic tumors, multiple investigations (17,18) have demonstrated the high efficacy of concurrent chemoradiotherapy (CCRT) in treating locally advanced thymic tumors. In the current study, due to cardiac and pulmonary function evaluations that did not support CCRT, radical radiotherapy was administered. The overall ORR for the entire cohort was 84.6%, highlighting the role of radiotherapy in local tumor control. Nevertheless, it is crucial to acknowledge that the small sample size and potential biases inherent in this study limit the robustness of these conclusions. The absence of a large-scale, multi-center study and the presence of mixed histological components also impinge on the precision of the interpretation.
The generalizability of the study results is potentially limited. The patients in this study were recruited from a single center, which may not be representative of the broader population of patients with stage IVA thymic tumors. The specific inclusion criteria, such as a tumor volume of ≥200 cm3 and inoperability, restrict the direct applicability of the results to patients with different tumor volumes or those who are operable. Furthermore, the small sample size and the presence of mixed histological components in the pathological types further circumscribe the generalizability of these findings. The lack of diversity in patient characteristics, including comorbidities and various histological subtypes, diminishes the external validity of the results. Larger-scale, multi-center studies with more heterogeneous patient populations are required to confirm and expand upon these findings.
Conclusions
Through retrospective analysis, radical IMRT is a safe and feasible treatment option for large-volume, unresectable stage IVA thymic tumors. It has achieved a high local control rate and acceptable adverse reactions. This approach can provide an effective and safe treatment strategy for more patients with large tumors. However, further verification is needed through more prospective randomized studies and larger retrospective datasets.
Acknowledgments
None.
Footnote
Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-888/rc
Data Sharing Statement: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-888/dss
Peer Review File: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-888/prf
Funding: This study was supported by
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-888/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethics Committee of Air Force Medical Center (No. 2025-90-PJ01). Informed consent was waived due to the use of anonymized, non-identifiable data.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- He T, Yao J, Chen J, et al. Postoperative radiotherapy for completely resected thymoma and thymic carcinoma: A systematic review and meta-analysis. PLoS One 2024;19:e0308111. [Crossref] [PubMed]
- Pavese V, Carfì FM, Capelletto E, et al. Therapeutic management of patients with advanced thymic malignancies: A review for clinicians. Lung Cancer 2025;204:108554. [Crossref] [PubMed]
- Danuzzo F, Sibilia MC, Vaquer S, et al. The Role of Hyperthermic Intrathoracic Chemotherapy (HITHOC) in Thoracic Tumors. Cancers (Basel) 2024;16:2513. [Crossref] [PubMed]
- Masui Y, Okuma Y. An update on the therapeutic options for metastatic thymomas and thymic carcinomas. Expert Rev Anticancer Ther 2025;25:853-63. [Crossref] [PubMed]
- Yamamoto Y, Iwahori K, Shintani Y. Current immunotherapy for thymic epithelial tumors: a narrative review. Mediastinum 2024;8:47. [Crossref] [PubMed]
- Koga K, Matsuno Y, Noguchi M, et al. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int 1994;44:359-67. [Crossref] [PubMed]
- Lang M, Anamaterou C, Mohr I, et al. A Review for the Clinician: Classifications, Genetics, and Treatment for Neuroendocrine Neoplasms of the Thymus (Thymic Carcinoids). Neuroendocrinology 2025; Epub ahead of print. [Crossref]
- de Jong WK, Blaauwgeers JL, Schaapveld M, et al. Thymic epithelial tumours: a population-based study of the incidence, diagnostic procedures and therapy. Eur J Cancer 2008;44:123-30. [Crossref] [PubMed]
- Zhao Y, Shi J, Fan L, et al. Surgical treatment of thymoma: an 11-year experience with 761 patients. Eur J Cardiothorac Surg 2016;49:1144-9. [Crossref] [PubMed]
- Litvak AM, Woo K, Hayes S, et al. Clinical characteristics and outcomes for patients with thymic carcinoma: evaluation of Masaoka staging. J Thorac Oncol 2014;9:1810-5. [Crossref] [PubMed]
- Huang J, Detterbeck FC, Wang Z, et al. Standard outcome measures for thymic malignancies. J Thorac Oncol 2011;6:S1691-7. [Crossref] [PubMed]
- Vogel J, Berman AT, Lin L, et al. Prospective study of proton beam radiation therapy for adjuvant and definitive treatment of thymoma and thymic carcinoma: Early response and toxicity assessment. Radiother Oncol 2016;118:504-9. [Crossref] [PubMed]
- Marzo AM, Cozzi L, Franceschini D, et al. Cardiac Exposure Related to Adjuvant Radiotherapy in Patients Affected by Thymoma: A Dosimetric Comparison of Photon or Proton Intensity-Modulated Therapy. Cancers (Basel) 2025;17:294. [Crossref] [PubMed]
- Bian D, Zhou F, Yang W, et al. Thymoma size significantly affects the survival, metastasis and effectiveness of adjuvant therapies: a population based study. Oncotarget 2018;9:12273-83. [Crossref] [PubMed]
- Safieddine N, Liu G, Cuningham K, et al. Prognostic factors for cure, recurrence and long-term survival after surgical resection of thymoma. J Thorac Oncol 2014;9:1018-22. [Crossref] [PubMed]
- Fukui T, Fukumoto K, Okasaka T, et al. Prognostic impact of tumour size in completely resected thymic epithelial tumours. Eur J Cardiothorac Surg 2016;50:1068-74. [Crossref] [PubMed]
- Fujimoto S, Katsurada N, Sasaki R, et al. Localized Unresectable Thymic Carcinoma Treated with Induction Chemotherapy with Lenvatinib before Radiotherapy. Intern Med 2025;64:1724-7. [Crossref] [PubMed]
- Tamiya A, Matsumura A, Tsuji T, et al. A pilot study of cisplatin and etoposide with and without radiotherapy for advanced malignant thymoma. Anticancer Res 2014;34:2023-7.
