Combination Short-Course Preoperative Irradiation, Surgical Resection, and Reduced-Field High-Dose Postoperative Irradiation in the Treatment of Tumors Involving the Bone

Journal Article · Thu Jan 01 00:00:00 EST 2009 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2008.03.074· OSTI ID:21172562

Kobayashi, Wendy; Dean, Susan; Goldberg, Saveli I ^[1]; Kirsch, David G ^[2]; Suit, Herman D ^[1]; Hornicek, Francis J; Pedlow, Francis X; Raskin, Kevin A; Springfield, Dempsey S ^[3]; Yoon, Sam S ^[4]; Gebhardt, Marc C ^[5]; Mankin, Henry J ^[3]; DeLaney, Thomas F ^[1]

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1. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)
2. Department of Radiation Oncology, Duke University School of Medicine, Durham, NC (United States)
3. Orthopaedic Oncology, Department of Orthopaedics, Massachusetts General Hospital, Boston, MA (United States)
4. Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA (United States)
5. Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Israel)

Purpose: To assess the feasibility and outcomes of combination short-course preoperative radiation, resection, and reduced-field (tumor bed without operative field coverage) high-dose postoperative radiation for patients with solid tumors mainly involving the spine and pelvis. Methods and Materials: Between 1982 and 2006, a total of 48 patients were treated using this treatment strategy for solid tumors involving bone. Radiation treatments used both photons and protons. Results: Of those treated, 52% had chordoma, 31% had chondrosarcoma, 8% had osteosarcoma, and 4% had Ewing's sarcoma, with 71% involving the pelvis/sacrum and 21% elsewhere in the spine. Median preoperative dose was 20 Gy, with a median of 50.4 Gy postoperatively. With 31.8-month median follow-up, the 5-year overall survival (OS) rate is 65%; 5-year disease-free survival (DFS) rate, 53.8%; and 5-year local control (LC) rate, 72%. There were no significant differences in OS, DFS, and LC according to histologic characteristics. Between primary and recurrent disease, there was no significant difference in OS rates (74.4% vs. 51.4%, respectively; p = 0.128), in contrast to DFS (71.5% vs. 18.3%; p = 0.0014) and LC rates (88.9% vs. 30.9%; p = 0.0011) favoring primary disease. After resection, 10 patients experienced delayed wound healing that did not significantly impact on OS, DFS, or LC. Conclusion: This approach is promising for patients with bone sarcomas in which resection will likely yield close/positive margins. It appears to inhibit tumor seeding with an acceptable rate of wound-healing complications. Dose escalation is accomplished without high-dose preoperative radiation (likely associated with higher rates of acute wound healing delays) or large-field postoperative radiation only (likely associated with late normal tissue toxicity). The LC and DFS rates are substantially better for patients with primary than recurrent sarcomas.

• OSTI ID: 21172562
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 73, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2008.03.074; PII: S0360-3016(08)00771-2; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
HEALING
IRRADIATION
OSTEOSARCOMAS
PATIENTS
PELVIS
PROTONS
RADIATION DOSES
RADIOTHERAPY
SURGERY
TOXICITY
VERTEBRAE
WOUNDS