American Radium Society appropriate use criteria for radiation therapy in the multicisciplinary management of thymic carcinoma

The oncologic management of thymic carcinoma is controversial due to a paucity of prospective data. Multidisciplinary consensus guidelines are crucial to guide oncologic management. The Thoracic Appropriate Use Criteria expert panel of the American Radium Society reviewed the medical literature from 1980 to 2021 to inform consensus guidelines. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. There was consensus that conventionally fractionated radiation (1.8-2.0 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate, and that elective nodal irradiation is inappropriate. The panel recommends use of IMRT or proton therapy rather than 3-dimensional conformal radiotherapy to reduce radiation exposure to heart and lungs.