Randomized, Multicenter, Phase III Trial to Assess Conformal Post-operative Radiotherapy vs. Surveillance After Complete Resection of Stage II/III Thymoma (RADIO-RYTHMIC-01)

Inclusion Criteria:

1. 18 < Age < 75 years old

2. ECOG performance status ≤1

3. Preoperative chemotherapy is allowed. Maximum of 4 cycles are authorized. Surgeryshould be realized ≤ 2 months after the last chemotherapy injection.

4. Histologically diagnosed thymoma at pathological examination of surgical specimenafter pathological review; for note, centralized, real-time, systematic pathologicalreview is standard through the RYTHMIC network in France

5. Complete resection at pathological examination of the surgical specimen aftersurgery conducted through standard, recommended approach ensuring accurateassessment of resection status

6. Stage IIb or III disease according to the Masaoka-Koga staging system; thiscorresponds to stage pT1a with capsule invasion, until stage pT3 N0 M0 in the 8thTNM staging system TNM UICC/AJCC

7. Availability of thoracic Computed-Tomography (CT) scan with IV contrast (in theabsence of contra-indications) or PET scan performed before surgery

8. Availability of a thoracic Computed-Tomography (CT) scan with IV contrast (in theabsence of contra-indications) showing absence of residual disease after surgicalresection of the tumor

9. Pulmonary function tests after surgery with FEV1 ≥ 1L or ≥ 35% of the theoreticalvalue and DLCO ≥ 40%

10. Signature of informed consent form

Exclusion Criteria:

• 1. Age > 75 years old 2. Histology of thymic carcinoma 3. Delivery of post-operative chemotherapy, concurrent chemotherapy to radiotherapy 4. Presence of microscopic or macroscopic residual tumor after surgery or metastases (R1 or R2 resection) 5. Uncontrolled, clinically significant pleural or pericardial effusion 6. Patients with prior radiation therapy to the thorax. Patients treated with conformal radiotherapy for prior breast or head and neck neoplasms should be discussed with PI 7. Evidence of severe or uncontrolled systemic disease as judged by the investigator 8. Recent (< 6 months) severe cardiac disease (uncontrolled arrhythmia, congestive heart failure, infarction, pace-maker) or pulmonary disease. Controlled and non clinically symptomatic arrhythmia is allowed.

9. Current or past history of neoplasm diagnosed within the last 3 years, except: basal cell carcinoma of the skin, in situ carcinoma of the cervix, and bladder in situ. A patient diagnosed for another neoplasm 3 years ago or more, treated and considered as cured may be included in the study if all the other criteria are respected 10. Pregnancy or breast feeding or inadequate contraceptive measures for women of childbearing potential during PORT 11. Patients who, for family, social, geographic or psychological reasons, cannot be adequately followed up and/or are incapable of undergoing regular controls, 12. Patients deprived of freedom or under guardianship