Liver resection (LR) and orthotopic liver transplantation (OLT) are therapeutic options for locally advanced perihilar cholangiocarcinoma (pCCA) requiring hepatic artery reconstruction (HAR). This study aimed to compare short- and long-term outcomes of LR and OLT. Outcomes were major vascular complications, 90-day mortality, overall survival (OS) and recurrence-free survival (RFS). A cohort of patients undergoing LR with HAR from 10 Western centres was compared with an OLT cohort comprising patients who received or did not receive neoadjuvant chemoradiotherapy (NACR). 109 patients, 60 LR and 49 OLT (22 OLT no-NACR and 27 OLT NACR) were included. LR patients were older and had fewer Bismuth type 4 tumours (38.3% vs. 69.4%, p = 0.009). Positive margins (49.2% vs. 6.5%, p < 0.001) and lymph nodes (54.2% vs. 32.4%, p = 0.058) were found more frequently in LR patients. No differences were found between LR and OLT in major (40% vs. 46.9%, p = 0.56) and vascular complications (23.3% vs. 28.6%, p = 0.66); NACR was an independent prognostic factor for vascular complications (OR 2.63, 95% CI 1.03-6.70, p = 0.043). 90-day mortality (15% for LR vs. 10.2% for OLT, p = 0.57) and 5-year OS (HR 0.68, 95% CI 0.40-1.17, p = 0.17) were similar. Median OS after LR versus OLT was higher but not significant (24 vs. 40 months, p = 0.13). OLT had better 5-year RFS (HR 0.52, 95% CI 0.29-0.96, p = 0.035) than LR. R1 resection (HR 2.07, 95% CI 1.03-4.18, p = 0.041) and perineural invasion (HR 3.64, 95% CI 1.09-12.16, p = 0.035) were independent prognostic factors for RFS. LR and OLT for locally advanced pCCA had similar rates of major complications and post-operative mortality, but NACR was associated with increased vascular complications. Survival was difficult to compare in the groups due to their heterogeneity, but OLT, especially with NACR, seems to give better results than LR.

Prediction of pneumonia following neoadjuvant chemoradiotherapy in patients with oesophageal cancer.

The precise prediction of survival outcomes in rectal cancer is essential for the development of personalized treatment strategies, particularly due to the heterogeneity in patient prognosis and response to therapy. The present study examined the prognostic significance of immune-inflammatory markers, in predicting outcomes of patients with stage II and III rectal cancer undergoing neoadjuvant chemoradiotherapy (NCRT). The present retrospective cohort analysis included 651 patients diagnosed with stage II/III rectal cancer, all of whom underwent NCRT as part of their treatment regimen. Data relative to clinical and pathological variables, including carcinoembryonic antigen (CEA), neutrophil count, lymphocyte count, eosinophil count and the neutrophil-to-lymphocyte ratio (NLR) were collected and examined. These variables were subjected to multivariate Cox regression analysis to independently predict overall survival (OS) and disease-free survival (DFS). Furthermore, prognostic nomograms were constructed and validated to enhance the prediction of patient outcomes. CEA, neutrophil count, lymphocyte count, eosinophil count and the NLR were determined to be independent predictors of OS and DFS in Cox regression analyses. A nomogram was constructed to incorporate these five prognostic biomarkers, which demonstrated good calibration and accurately predicted outcomes, with close agreement between the predicted and observed results. Notably, elevated post-NCRT NLR was significantly associated with poorer survival. In conclusion, the present study constructed and validated a prognostic model to predict OS and DFS in patients with stage II/III rectal cancer receiving NCRT, based on readily accessible clinical biomarkers. This model may have potential clinical utility for prognosis.

This study aimed to investigate the spatiotemporal correlation between tumor metabolism and cancer-associated fibroblast activity using dual-tracer PET/CT, and to explore their potential association with pathologic response to neoadjuvant chemoradiotherapy (nCRT) in esophageal squamous cell carcinoma (ESCC). This retrospective analysis of a prospective trial (ChiCTR2100051599) included 48 patients with ESCC from February 2022 to August 2024. All patients underwent 68Ga-FAPI and 18F-FDG PET/CT before pre-nCRT (S1) and after nCRT (S2). Two primary metrics were used to quantify their spatial correlations by voxel-wise correlation analyses: the SUV Correlation Coefficient (SUV_R), reflecting static uptake concordance, and the Dose-Response Matrix Correlation Coefficient (DRM_R), reflecting concordance in treatment dose sensitivity. The conventional parameters derived from FAPI- and FDG- PET were also extracted: SUVmax, SUVmean, SUV_CV, SUVmaxratio, SUVmeanratio, DRMmax, DRMmedian, DRM_CV and the resistant tumor volume (V(DRM> 0.7)). The associations of these metrics with pathological tumor regression grade (TRG) were evaluated in an exploratory manner, except for DRM-related metrics. A strong voxel-wise correlation was observed between pre-nCRT FAPI and FDG uptake (S1 SUV_R = 0.80 ± 0.17), which was weaker after nCRT (S2 SUV_R = 0.51 ± 0.23). Two dose-response matrices showed a strong correlation (DRM_R = 0.82 ± 0.14). The bivariate Logistic model, integrating the post-treatment SUV_R and SUV_CV_FDG, significantly predicted pathological response (p = 0.007), achieving an optimization-corrected AUC of 0.78 (95%CI: 0.62-0.95). The pre-nCRT tumor voxel intensity and dose response constructed using either FDG or FAPI PET imaging exhibited a strong spatial correlation. In this exploratory analysis, the post-nCRT FAPI-FDG correlation coefficient was associated with pathologic response when combined with SUV_CV_FDG in a Logistic model.

Incorporating Individual Early Response in the Dose-Effect Relationship of Complete Pathological Response Following Neoadjuvant Radiochemotherapy for Rectal Cancer.

Standard treatment for locally advanced rectal cancer involves neoadjuvant chemoradiation therapy (nCRT) followed by total mesorectal excision, but this approach carries significant morbidity and often results in incomplete resections owing to poor intraoperative tumor visualization. For patients with complete response to nCRT, a watch-and-wait (W&W) strategy can spare surgery, but current imaging techniques inadequately identify complete responders, leading to regrowth in ~30% of cases. To improve nCRT response assessment and guide resections, we developed PH10, a topically applied, pH-activatable near-infrared (NIR) fluorescent probe for rapid, tumor-specific imaging. PH10, a small-molecule cyanine analog, was tested in murine models and on human tumor specimens (n = 11). Fluorescence activation, tumor specificity, and tumor-to-background ratio (TBR) were evaluated in vivo and ex vivo within clinically relevant timeframes. PH10 enabled rapid and specific tumor visualization, achieving a median TBR of 3.2 within 1 min in vivo in murine models and 2.2 within 10 min ex vivo on human samples. The probe demonstrated high specificity for tumor tissue within the acidic tumor microenvironment without requiring systemic administration or prolonged incubation. PH10 is a promising, fast-acting topical NIR agent for real-time tumor detection during colorectal cancer endoscopy and surgery. Its simplicity and rapid kinetics support potential clinical translation. Moreover, its pH-activatable mechanism may extend its utility to other solid cancers with acidic microenvironments.

The optimal extent of lymphadenectomy following neoadjuvant chemoimmunotherapy (nCIT) for esophageal squamous cell carcinoma (ESCC) remains unclear. Current recommendations are largely derived from neoadjuvant chemoradiotherapy cohorts, and their applicability in the era of immunotherapy is unclear. This study evaluated the association between lymph node dissection (LND) yield and disease-free survival (DFS) in patients with ESCC treated with nCIT. This retrospective multicenter cohort study included 465 patients with ESCC who underwent nCIT followed by radical esophagectomy at six hospitals in China between January 2019 and December 2023. The median follow-up was 40.7 months. The total number of dissected lymph nodes was analyzed in relation to DFS. The restricted mean survival time at 5 years was estimated by using random survival Forest-based models, with subgroup analyses by posttherapy pathological stage (ypT/ypN). A higher lymph node yield was associated with improved DFS, although the relationship was nonlinear and varied by pathological subgroup. In patients with ypT0-2N0 disease, DFS improved with increasing LND up to approximately 20-30 lymph nodes, after which the benefit plateaued. In patients with residual nodal disease (ypN1-3), higher lymph node yields were associated with longer DFS, with greater yields observed in more advanced disease stages. Across all subgroups, lower lymph node yields were consistently associated with inferior DFS. In this multicenter cohort of patients with ESCC treated with nCIT, lymph node yield was associated with DFS in a stage-dependent manner, suggesting its potential role as a postoperative quality indicator for surgical lymphadenectomy after nCIT.

Recent advancements of neoadjuvant strategies in locally advanced rectal cancer.

Phase II randomized trial of 41.4Gy vs. 50.4Gy in neoadjuvant chemoradiotherapy for resectable esophageal cancer.

Prediction of treatment outcomes is essential for improving clinical management, particularly in patients with soft tissue sarcoma, where treatment options remain suboptimal. Given the limitations of current therapies, there is increasing interest in combining neoadjuvant radiotherapy with immunotherapy, referred to as neoadjuvant radioimmunotherapy (NRIT). We aim to develop a predictive model for assessing pathologic treatment response in patients undergoing NRIT or chemoradiotherapy, integrating radiomic features with radiologist assessments, clinical data, and pathology findings. Radiomic and semantic features were extracted from pre- and post-treatment MRI scans. The XGBoost algorithm was used for feature selection and model development. Models included a model based on clinical variables and semantic features, a model based on radiomic features and clinical features and a model using all available features. Study cohort included 213 patients (mean age of 54years, male/female of 1.6). There were 17 patients in the prospective arm. The best model used all radiomic, clinical, and semantics features. It achieved an area under the receiver operating characteristic curve (AUC) of 0.72 (95% CI = 0.51-0.89) on the hold-out testing set. Multi-modal radiomic-based models are effective in identifying patients at higher risk of non-response to neoadjuvant therapy. Furthermore, the performance of multi-modal radiomics-based models exceeded those based solely on radiologist evaluations. Our findings underscore the potential of radiomics in enhancing precision medicine by enabling identification of treatment response in STS patients undergoing NRIT before surgical excision of the tumor.

Total neoadjuvant therapy versus standard neoadjuvant chemoradiotherapy for locally advanced rectal cancer: A systematic review and meta-analysis of long-term outcomes.

The treatment of locally advanced (LARC) and locally recurrent (LRRC) rectal cancers poses significant challenges due to the anatomical complexity and the aggressive nature of tumor invasion. The adoption of multidisciplinary team (MDT) treatment models has become key to improving patient outcomes. Within the MDT framework, advances in imaging and pathology facilitate accurate assessment of disease. In minimally invasive surgery, urinary system reconstruction and pelvic floor reconstruction techniques have significantly improved outcomes for patients undergoing surgery. MDT decision-making plays a particularly important role in the selection of neoadjuvant treatment strategies: The MDT must weigh up the benefits and risks while taking into account the patient's primary disease, as well as their physical and mental condition, and strictly adhere to the indications for pelvic exenteration (PE) surgery. For patients without mesorectal involvement, neoadjuvant chemotherapy alone has demonstrated comparable efficacy to neoadjuvant chemoradiotherapy while exhibiting lower toxicity, but its application in T4b patients requires further validation. In conclusion, the treatment of LARC/LRRC has entered the era of multidisciplinary precision, and the MDT model is the core mechanism for integrating technological innovation and evidence to continuously improve patients' survival and quality of life. The future direction of development under the MDT model focuses on the integration of imaging and liquid biopsy for precise stratification, the optimization of the cost of robotic surgery and the innovation of bioprosthetic materials, the clarification of the optimal preoperative plan through multicenter studies, and exploring immune-based/targeted combination strategies.

Objective: To investigate the risk factors of long-term (>3 months) severe anastomotic complications after rectal cancer surgery. Methods: A case-control study was employed, with the following inclusion criteria for cases: (1) age between 18 and 80 years; (2) history of radical surgery for rectal cancer; (3) tumor located ≤10 cm from the anal verge; (4) occurrence of long-term (>3 months) severe anastomotic complications (e.g., refractory local infection or intestinal obstruction) requiring transverse colostomy; (5) complete clinical data. Exclusion criteria: (1) transverse colostomy due to local recurrence or extensive peritoneal metastasis; (2) transverse colostomy due to non-anastomotic complications(e.g., radiation enteritis, fecal incontinence, anal pain); (3) extensive liver or lung metastasis; (4) loss to follow-up. This study defined long-term severe anastomotic complications as complications requiring readmission for transverse colostomy, including anastomotic leakage, sinus tract formation, anastomotic stenosis, and intestinal obstruction. According to the above criteria, a retrospective collection was conducted on 107 patients who underwent transverse colostomy after rectal cancer surgery at Shanghai Changhai Hospital from May 2014 to June 2024 due to long-term severe anastomotic complications (severe anastomotic complications group). 737 patients who underwent radical surgery for rectal cancer at the same hospital from January 2019 to December 2019 were selected from the clinical database as the control group. The inclusion criteria for the control group are as follows: (1) age between 18 and 80 years; (2) history of radical surgery for rectal cancer in our hospital; (3)tumor located ≤10 cm from the anal verge; (4) complete clinical data. No transverse colostomy, recurrence, metastasis, death, or loss to follow-up were included. The observation indicators of this study were risk factors associated with long-term severe anastomotic complications. The variables analyzed included: gender, age, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), body mass index (BMI), preoperative hemoglobin, preoperative albumin, tumor distance from the anal verge, stoma construction status, postoperative tumor T stage, postoperative tumor N stage, maximum tumor diameter, KRAS mutation, NRAS mutation, BRAF mutation, neoadjuvant chemoradiotherapy status, adjuvant chemoradiotherapy status, and perirectal fat space (PFS). Preoperative images with fat quantification sequences of the rectum were acquired via the Picture Archiving and Communication System (PACS), followed by quantification of perirectal fat areas at superior and inferior tumor margins using ImageJ software. Results: Among 107 rectal cancer patients undergoing transverse colostomy for long-term severe anastomotic complications, 85 were male (79.4%) and 22 female (20.6%), with BMI (22.3±3.1) kg/m². Twenty-nine patients (27.1%) had no radiotherapy exposure, while 78 (72.9%) received radiotherapy, including 31 (39.7%) preoperatively and 47 (60.3%) postoperatively. The long-term severe anastomotic complications comprised two categories:(1) fistulas in 47 cases (43.9%): including anastomotic, rectovaginal, rectourethral, and rectovesical fistulas; (2) anastomotic stenosis in 60 cases (56.1%). Univariate analysis demonstrated significantly higher proportions of male patients, advanced age, postoperative T/N stages, and radiotherapy history, but lower BMI in the severe anastomotic complications group versus controls (all P<0.05). Multivariate analysis identified male sex (OR=2.435, 95%CI:1.333-4.447, P=0.004), advanced age (OR=1.035, 95%CI:1.010-1.060, P=0.005), T4 stage (OR=14.634, 95%CI:2.096-102.187, P=0.007), N2 stage (OR=2.014, 95%CI:1.043-3.888, P=0.037), low BMI (OR=1.175, 95%CI:1.080-1.278, P<0.001), and radiotherapy (OR=9.759, 95%CI:5.517-17.264, P<0.001) as independent risk factors. Propensity score matching was further performed in patients receiving radiotherapy, with PFS measurements at both superior and inferior tumor margins. Matched cohorts comprised 78 patients each. Univariate analysis revealed higher male proportion but lower BMI, superior PFS, and inferior PFS in the severe anastomotic complications group (all P<0.05). Multivariate analysis confirmed male sex (OR=2.756, 95%CI:1.130-6.720, P=0.026), low BMI (OR=1.169, 95%CI:1.033-1.324, P=0.013), and reduced inferior PFS (OR=1.021, 95%CI:1.001-1.042, P=0.041) as independent predictors. Conclusion: Radiotherapy significantly contributes to long-term severe anastomotic complications. Male patients exhibiting low BMI and diminished PFS at inferior tumor margins demonstrate the highest risk profile.

The selection of appropriate machine learning (ML) methods for clinical research remains challenging, particularly when both predictive performance and model explainability are required in small-sample datasets. Conventional approaches often rely on limited variables and expert-driven choices, whereas many ML models remain difficult to justify clinically. This study aimed to develop an explainable ML model selection pipeline and demonstrate its application in predicting neoadjuvant chemoradiotherapy (nCRT) response in locally advanced rectal cancer (LARC). We proposed a six-stage explainable ML model selection pipeline comprising data selection and preprocessing, algorithm pool construction, model training, model evaluation, model explanation, and an internal clinical logic consistency check (non-deployable sanity check). The workflow was applied to a retrospective cohort of 128 patients with LARC treated with nCRT. Four ML algorithms, including support vector machine (SVM), decision tree (DT), random forest (RF), and logistic regression (LR), were evaluated. Model performance was assessed using accuracy, F1-score, AUROC, AUPRC, bootstrap confidence intervals, and five-fold cross-validation, followed by explainability screening using SHAP. Under predefined screening criteria, DT models achieved the most favorable balance between predictive performance and explainability. Using pretreatment tumor markers alone, the selected DT models achieved an accuracy of 0.82 and F1-score of 0.71 for pathological complete response (pCR) prediction, and an accuracy of 0.76 and F1-score of 0.72 for tumor regression grade (TRG) prediction. SHAP analysis consistently identified carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) as the most influential predictors, and lower baseline levels of these markers were associated with better pathological response. This study provides a practical and reproducible framework for selecting interpretable ML models in small clinical datasets. In the present LARC case study, DT-based models showed acceptable discrimination and transparent decision logic, while tumor markers emerged as clinically plausible predictors of nCRT response. The proposed workflow may support future multi-center validation and broader application in clinically interpretable predictive modeling.

Neoadjuvant chemoradiotherapy (CRT) constitutes a standard treatment for locally advanced rectal cancer (RC), frequently followed by radical surgical resection. Yet, therapeutic responses vary widely, and intrinsic radioresistance remains a major barrier to cure. To uncover actionable determinants of CRT response, we established a panel of patient-derived colorectal cancer cell lines (PDCLs) followed by integrated phenotypic and functional characterization. We identified metabolic reprogramming as a hallmark of radioresistance and, through orthogonal validation experiments, confirmed elevated glycolytic and mitochondrial ATP production in (chemo)irradiation-resistant PDCLs. The causative relationship of this association and its potential for therapeutic intervention was shown by subsequent drug screening, showing resistance to most of the applied drugs and revealing a critical dependency on the monocarboxylate transporter (MCT1) and the glucose transporter 1 (GLUT1). Metabolism-targeting compounds re-sensitized resistant PDCLs to irradiation; especially inhibition of GLUT1 exhibits a robust radiosensitizing activity across models. Concordantly, GLUT1 expression correlated with poor response to neoadjuvant CRT in our own RC patient cohort and various publicly available patient datasets. Collectively, our study defines metabolic dependency as a key driver of CRT resistance in RC, and reveals glycolysis- and lactate-transport-associated pathway activities as targetable vulnerabilities. These findings provide a mechanistic basis for patient stratification and support the development of metabolism-directed strategies to overcome (chemo)radioresistance in RC.

Radiotherapy is important for advanced and metastatic gastric cancer (GC), but radioresistance limits its benefit. Pyroptosis has emerged as a potential strategy to overcome radioresistance, yet its regulatory mechanisms remain unclear. Using LC-MS/MS-based proteomic profiling of tumor tissues from patients with GC treated with neoadjuvant chemoradiotherapy, we identified tumor-intrinsic lymphotoxin beta receptor (LTβR), previously considered mainly an immune cell membrane protein, as a candidate determinant of poor radiotherapy response. Functional studies in GC cell lines, xenografts, and patient-derived organoids (PDOs) showed that LTβR depletion enhanced radiosensitivity, whereas LTβR overexpression promoted radioresistance. Integrated RNA-seq, Ribo-seq, and polysome profiling showed that LTβR loss reduced translational efficiency of SARM1 under irradiation. Mechanistically, irradiation increased LTβR stability in a glycosylation-dependent manner and promoted nuclear translocation. In the nucleus, LTβR enhanced TRIM28-mediated SUMOylation of PCBP2, promoting cytoplasmic redistribution of PCBP2 and increased translational efficiency of SARM1. Consistently, LTβR suppressed irradiation-induced pyroptosis through the NLRP3/caspase-1/GSDMD pathway. We further identified EMD638683 as an LTβR-binding compound through structure-based virtual screening, and showed that cRGD-modified liposomes improved its tumor-targeted delivery and enhanced LTβR reduction, radiosensitization, and tumor suppression in PDO and xenograft models. Together, these findings highlight LTβR as a promising therapeutic target to improve radiotherapy efficacy in GC.

Transanal minimally invasive surgery (TAMIS) emerged as a validated technique for local excision of rectal adenomas and early-stage adenocarcinomas. In organ preservation protocols, TAMIS is increasingly used for mid- and low-rectal cancers, achieving complete or major clinical response (cCR/cMR) following neoadjuvant chemoradiotherapy, complementing Watch-and-Wait strategies with low morbidity and favorable outcomes. Robotic platforms, particularly the Da Vinci SP, have improved surgical dexterity and visualization in confined pelvic spaces. Despite CE approval and encouraging feasibility data, widespread adoption of SP-TAMIS remains limited due to docking constraints. This study reports the first European series of rectal cancer cases treated with SP-TAMIS (SPrTAMIS) using a novel small FishBowl docking system and evaluates its feasibility, safety, and short-term outcomes. Five patients with rectal adenocarcinoma, selected based on organ preservation criteria, underwent SPrTAMIS using the Da Vinci SP system. Preoperative assessment included endoscopy, MRI, CT, and bowel preparation. Procedures were performed under general anesthesia with CO2 pneumorectum (12mmHg) and robotic instrumentation via the FishBowl docking system. Data collected included tumor characteristics, surgical duration, estimated blood loss (EBL), morbidity, mortality, length of stay (LOS), and functional outcomes (LARS and MSKCC scores). All procedures were completed robotically without conversion. The mean lesion size was 8.8mm, located 50mm from the anal verge and 16mm from the anorectal junction. Mean operative time was 85 minutes. No intraoperative complications or mortality occurred. GI function resumed by postoperative day (POD) 1; all patients were discharged by POD 2. One minor, asymptomatic suture dehiscence was observed. Histology confirmed complete excision with negative margins. The median follow-up was 68 days, and functional and quality-of-life outcomes were favorable. SPrTAMIS using Da Vinci SP and the FishBowl system is feasible and safe for rectal excision, offering ergonomic advantages and minimal anal canal trauma. Further studies are warranted to assess long-term oncologic and functional outcomes.

Low anterior resection syndrome (LARS) is common after neoadjuvant chemoradiotherapy (nCRT) and sphincter-preserving surgery for rectal cancer and is associated with poor quality of life. However, reliable tools to identify patients at high risk remain limited. This study aims to develop and validate a prediction model for major LARS in patients with rectal cancer after nCRT and sphincter-preserving surgery. A total of 315 consecutive patients between 2019 and 2021 were retrospectively enrolled (training cohort: 213; independent validation cohort: 102). A distal resection margin collagen score (CSDRM) was derived from multiphoton imaging using least absolute shrinkage and selection operator (LASSO) logistic regression. A prediction nomogram incorporating CSDRM and clinicopathologic factors was developed and evaluated for discrimination, calibration, and clinical utility. The CSDRM was developed on the basis of eight features. Multivariable analysis revealed that the CSDRM (odds ratio [OR] 3.57, 95% confidence interval [CI] 2.56-5.37), tumor distance from the anal verge, and time to stoma closure were independent predictors of major LARS. The CSDRM-integrated nomogram showed good discrimination in the training cohort (area under the receiver operating characteristic curve [AUROC], 0.914, 95% CI 0.863-0.957) and validation cohort (AUROC 0.922, 95% CI 0.851-0.976). Compared with the traditional model, incorporating CSDRM significantly improved discrimination in both the training cohort (AUROC 0.914 versus 0.631; p < 0.001) and validation cohort (AUROC, 0.922 versus 0.619; p < 0.001). The CSDRM was associated with major LARS after nCRT and sphincter-preserving surgery. The CSDRM-integrated model may support postoperative risk stratification for major LARS in patients with rectal cancer.

We aimed to evaluate current practices among radiation oncologists in Turkey in the treatment of thymoma patients, including preferred staging systems, indications for adjuvant radiotherapy (RT), and RT dose schemes. We distributed a 19-item online questionnaire to 120 radiation oncologists affiliated with the TROD Thoracic Oncology Working Group. The survey covered demographics, clinical workflow, treatment indications, staging system preferences, guideline utilization, and RT dose regimens. Fifty-three physicians participated. Most had ≥ 10years of experience (85%) and academic titles (60%). A thoracic oncology tumor board was operated in 60.4% of centers. The Masaoka staging system was preferred by 66%, while TNM was used by 28.3%. In stage II thymoma patients with R0 resection, 67.9% recommended adjuvant RT regardless of histological subtype if there was capsular proximity. In stage IIA, the indication for RT was especially frequent for B2-B3 histology (45.3%), and similarly in stage IIB (43.4%). For locally advanced but potentially resectable cases, 43.4% favored induction chemotherapy followed by surgery, and 28.3% performed postoperative RT. In potentially unresectable disease, neoadjuvant chemoradiotherapy (47.2%) and definitive chemoradiotherapy (35.8%) were common. Postoperative RT doses varied: R0 resections most often received 45-50 Gy (85%), rising to 50-54 Gy (79.2%) if capsular proximity was present. R1 resections more often received 50-54 Gy (41.5%) or 54-60 Gy (39.6%). R2 disease was usually treated with higher doses (54-70 Gy, most frequently 66-70 Gy at 37.7%). After induction chemotherapy, neoadjuvant RT most commonly used 45-50 Gy (67.9%), while definitive RT typically used 60-66 Gy (43.4%) or 66-70 Gy (39.6%). Multidisciplinary management aligned with international guidelines is common in thymoma treatment in Turkey. Capsular proximity and histological subtype are key determinants for adjuvant RT decisions. Postoperative RT doses were escalated according to residual tumor burden and resection status. In locally advanced or unresectable cases, neoadjuvant strategies are widely adopted.

ASO Visual Abstract: Impact of Muscle Mass Loss on Survival During Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma: A Multi-Center Retrospective Study in China (TIMES Study).