In locally advanced thymic carcinoma where complete resection is not achievable upfront, a curative-intent sequential strategy is used: induction chemotherapy is administered first, with the aim of rendering the tumour resectable. When resectability remains the clinical question after that induction phase, a defined surgical protocol takes over.
Thymic carcinoma, Masaoka-Koga stage III–IVA (TNM stage IIIA–IIIB–IVA). Complete resection was not deemed achievable on upfront imaging assessment. No lymphogenous or haematogenous metastasis is present.
This staging encompasses tumours classified as T3 (stage IIIA), T4 (stage IIIB), or pleural/pericardial dissemination (stage IVA) in the IASLC/ITMIG TNM proposed system — tumours for which primary surgery alone is frequently insufficient.
The preceding step was primary/induction cisplatin-based combination chemotherapy, administered as part of a sequential curative-intent strategy. The specific goal of that induction phase was reassessment of resectability after two to four cycles — the tumour was expected to become resectable.
This protocol addresses the management decision that follows when that reassessment has been completed.
For patients in whom complete resection is now deemed achievable, surgery is the central intervention — extended resection may be required in certain cases. The full protocol specifies the criteria that determine surgical eligibility at this reassessment point, and what structured locoregional management follows the operative step.
Full regimen details, sequencing criteria, and treatment parameters are in the complete protocol.