{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T09:14:07Z","timestamp":1770369247425,"version":"3.49.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003819","name":"Natural Science Foundation of Hubei Province","doi-asserted-by":"publisher","award":["2025AFD879"],"award-info":[{"award-number":["2025AFD879"]}],"id":[{"id":"10.13039\/501100003819","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to compare dosimetric differences and normal tissue complication probability (NTCP) among coplanar intensity-modulated radiation therapy (CO-IMRT), non-coplanar IMRT (NONCO-IMRT), coplanar volumetric-modulated arc therapy (CO-VMAT), and non-coplanar VMAT (NONCO-VMAT) in thymoma radiotherapy and clarify the value of non-coplanar plans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Forty-eight post-thymoma surgery patients were enrolled in this study. Four radiotherapy plans (50 Gy\/25 fractions) were made for each patient. The target conformity index (CI), homogeneity index (HI), and organ-at-risk (OAR) (lungs, heart, etc.) dose parameters were then evaluated. NTCP was calculated using the Lyman\u2013Kutcher\u2013Burman (LKB) model. Statistical analysis was performed using the Student\u2013Newman\u2013Keuls (SNK-q) test (p &amp;lt; 0.05 for significance).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were no significant clinical differences in target volume coverage and homogeneity among the four plans. The lung V\n                      <jats:sub>20<\/jats:sub>\n                      , heart V\n                      <jats:sub>30<\/jats:sub>\n                      , spinal cord D\n                      <jats:sub>max<\/jats:sub>\n                      , and esophagus D\n                      <jats:sub>max<\/jats:sub>\n                      of the VMAT techniques were all lower than those of IMRT (p &amp;lt; 0.001). The breast dose of CO-VMAT was significantly higher, while the breast parameters of NONCO-VMAT were close to those of IMRT. NTCP results were consistent with dosimetric findings: VMAT plans had lower NTCP for the heart, spinal cord, and esophagus; moreover, the breast NTCP of CO-VMAT was significantly increased (1.75%), while that of NONCO-VMAT decreased to 0.28%, which was similar to that of IMRT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>All four plans meet the thymoma target dose requirement. However, NONCO-VMAT is preferred for its advantages in multi-organ protection and balanced breast dose. Additionally, CO-VMAT should be used cautiously in female patients due to the higher breast dose.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1730138","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T05:22:31Z","timestamp":1770268951000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dose and normal tissue complication probability analysis of various radiotherapy regimens for thymomas"],"prefix":"10.3389","volume":"16","author":[{"given":"Wu","family":"Xiandong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luo","family":"Haifeng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhichao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Chao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hu","family":"Yan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Jingjing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000294","article-title":"Approaching the patient with an anterior mediastinal mass: a guide for clinicians","volume":"9","author":"Carter","year":"2014","journal-title":"J Thorac Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-2019-thym-02","article-title":"Epidemiology of thymoma","volume":"12","author":"Rich","year":"2020","journal-title":"J Thorac Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jtcvs.2014.09.124","article-title":"Thymic carcinoma outcomes and prognosis: results of an international analysis","volume":"149","author":"Ahmad","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000128","article-title":"Thymic carcinoma: a cohort study of patients from the European Society of Thoracic Surgeons database","volume":"9","author":"Ruffini","year":"2014","journal-title":"J Thorac Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"330","DOI":"10.3389\/fonc.2013.00330","article-title":"Radiotherapy for thymic carcinoma: adjuvant, inductive, and definitive","volume":"3","author":"Komaki","year":"2013","journal-title":"Front Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2020.12.023","article-title":"Postoperative radiotherapy for completely resected Masaoka\/Masaoka-Koga stage II\/III thymoma improves overall survival: an updated meta-analysis of 4746 patients","volume":"16","author":"Tateishi","year":"2021","journal-title":"J Thorac Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"4938","DOI":"10.3390\/cancers14194938","article-title":"The prognostic value of postoperative radiotherapy for thymoma and thymic carcinoma: a propensity-matched study based on SEER database","volume":"14","author":"Zhang","year":"2022","journal-title":"Cancers (Basel)"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2017.01.002","article-title":"The impact of postoperative radiotherapy for thymoma and thymic carcinoma","volume":"12","author":"Jackson","year":"2017","journal-title":"J Thorac Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2016.06.011","article-title":"Postoperative radiation therapy is associated with longer overall survival in completely resected stage II and III thymoma: an analysis of the International Thymic Malignancies Interest Group retrospective database","volume":"11","author":"Rimner","year":"2016","journal-title":"J Thorac Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdv277","article-title":"Thymic epithelial tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up","volume":"26","author":"Girard","year":"2019","journal-title":"Ann Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1209825","article-title":"Risk of ischemic heart disease in women after radiotherapy for breast cancer","volume":"368","author":"Darby","year":"2013","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.54.4601","article-title":"Breast cancer after chest radiation therapy for childhood cancer","volume":"32","author":"Moskowitz","year":"2014","journal-title":"JCO"},{"key":"B13","doi-asserted-by":"publisher","first-page":"155015","DOI":"10.1088\/1361-6560\/ac7c50","article-title":"On the risk of secondary cancer from thymoma radiotherapy","volume":"67","author":"Jalbout","year":"2022","journal-title":"Phys Med Biol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-020-03281-z","article-title":"Volumetric modulated arc therapy versus intensity-modulated proton therapy in the postoperative irradiation of thymoma","volume":"146","author":"Franceschini","year":"2020","journal-title":"J Cancer Res Clin Oncol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2409","DOI":"10.3390\/cancers14102409","article-title":"Secondary Malignancy risk following proton vs X-ray radiotherapy of thymic epithelial tumors: a comparative modeling study of thoracic organ-specific cancer risk","volume":"14","author":"K\u00f6nig","year":"2022","journal-title":"Cancers (Basel)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"5153","DOI":"10.3390\/cancers13205153","article-title":"Estimated risk of radiation-induced cancer after thymoma treatments with proton- or X-ray beams","volume":"13","author":"Lidest\u00e5hl","year":"2021","journal-title":"Cancers (Basel)"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2017.04.022","article-title":"Predicted rate of secondary Malignancies following adjuvant proton versus photon radiation therapy for thymoma","volume":"99","author":"Vogel","year":"2017","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.21037\/qims-21-1101","article-title":"Analysis of deep inspiration breath-hold technique to improve dosimetric and clinical advantages in postoperative intensity-modulated radiation therapy for thymomas","volume":"12","author":"Yan","year":"2022","journal-title":"Quant Imaging Med Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e3181f20ea2","article-title":"Technical advances of radiation therapy for thymic Malignancies","volume":"5","author":"Gomez","year":"2010","journal-title":"J Thorac Oncol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"20180908","DOI":"10.1259\/bjr.20180908","article-title":"Recent developments in non-coplanar radiotherapy","volume":"92","author":"Smyth","year":"2019","journal-title":"Br J Radiol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2013.02.002","article-title":"4\u03c0 noncoplanar stereotactic body radiation therapy for centrally located or larger lung tumors","volume":"86","author":"Dong","year":"2013","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3769","DOI":"10.1120\/jacmp.v13i6.3769","article-title":"Noncoplanar intensity-modulated radiation therapy for young female patients with mediastinal lymphoma","volume":"13","author":"Chen","year":"2012","journal-title":"J Appl Clin Med Phys"},{"key":"B23","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s00066-011-0015-x","article-title":"Prescribing, recording, and reporting photon-beam intensity-modulated radiation therapy (IMRT)","volume":"188","author":"Hodapp","year":"2012","journal-title":"Strahlenther Onkol"},{"key":"B24","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.2307\/3576626","article-title":"Complication probability as assessed from dose-volume histograms","volume":"104","author":"Lyman","year":"1985","journal-title":"Radiat Res"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1118\/1.598063","article-title":"Reporting and analyzing dose distributions: a concept of equivalent uniform dose","volume":"24","author":"Niemierko","year":"1997","journal-title":"Med Phys"},{"key":"B26","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1016\/j.ijrobp.2022.08.039","article-title":"Parameters of the Lyman model for calculation of normal-tissue complication probability: a systematic literature review","volume":"115","author":"Dennst\u00e4dt","year":"2022","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(02)03986-X","article-title":"Comparing different NTCP models that predict the incidence of radiation pneumonitis","volume":"55","author":"Seppenwoolde","year":"2003","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B28","doi-asserted-by":"publisher","first-page":"103788","DOI":"10.1016\/j.breast.2024.103788","article-title":"Estimating the risk of major adverse cardiac events following radiotherapy for left breast cancer using a modified generalized Lyman normal-tissue complication probability model","volume":"77","author":"Lai","year":"2024","journal-title":"Breast"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2010.09.025","article-title":"Analysis of acute radiation-induced esophagitis in non-small-cell lung cancer patients using the Lyman NTCP model","volume":"97","author":"Zhu","year":"2010","journal-title":"Radiother Oncol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/52\/7\/005","article-title":"Normal tissue complication probability modelling of tissue fibrosis following breast radiotherapy","volume":"52","author":"Alexander","year":"2007","journal-title":"Phys Med Biol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.canrad.2021.07.037","article-title":"Dosimetric analysis of postoperative radiotherapy for thymoma","volume":"26","author":"He","year":"2022","journal-title":"Cancer Radiother"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1730138\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T05:22:32Z","timestamp":1770268952000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1730138\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":31,"alternative-id":["10.3389\/fonc.2026.1730138"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1730138","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,5]]},"article-number":"1730138"}}