Optimising individualised treatment decisions for locally advanced thymoma: precision selection of minimally invasive surgery and postoperative adjuvant radiotherapy

Locally advanced thymoma is characterised by significant heterogeneity and complex biological behaviour, and its optimal treatment strategy has long been controversial. The integration of minimally invasive surgical techniques and advanced radiotherapy technologies is refining the standard treatment mode towards individualised decision-making. This article reviews the latest evidence-based medical progress regarding the selection of surgical approaches and postoperative adjuvant treatment decisions for locally advanced thymoma in recent years. Regarding surgical treatment, the application boundaries of robotic and thoracoscopic minimally invasive surgery in locally advanced cases are analysed, indicating that when complete tumour resection (R0) is ensured, minimally invasive surgery can yield oncological outcomes non-inferior to those of open surgery and significantly reduce perioperative complications. Regarding radiation therapy, the evolution of indications for postoperative radiotherapy (PORT) is discussed, emphasising the critical role of risk stratification models based on WHO histological classification, resection margin status, and tumour burden in guiding radiotherapy decisions, and the potential of new technologies such as proton therapy in reducing cardiac toxicity is evaluated. This article aims to construct a dynamic individualised treatment decision-making framework by integrating multidisciplinary perspectives, providing a theoretical basis and practical guidance for clinicians to balance oncological efficacy and patient quality of life.