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

Abstract

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 significantlymore » 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.« less

Authors:
; ;  [1];  [2];  [1]; ; ; ;  [3];  [4];  [5];  [3];  [1]
  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)
Publication Date:
OSTI Identifier:
21172562
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 73; Journal 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); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; HEALING; IRRADIATION; OSTEOSARCOMAS; PATIENTS; PELVIS; PROTONS; RADIATION DOSES; RADIOTHERAPY; SURGERY; TOXICITY; VERTEBRAE; WOUNDS

Citation Formats

Wagner, Timothy D., Kobayashi, Wendy, Dean, Susan, Goldberg, Saveli I, Kirsch, David G, Suit, Herman D, Hornicek, Francis J, Pedlow, Francis X, Raskin, Kevin A, Springfield, Dempsey S, Yoon, Sam S, Gebhardt, Marc C, Mankin, Henry J, and DeLaney, Thomas F. Combination Short-Course Preoperative Irradiation, Surgical Resection, and Reduced-Field High-Dose Postoperative Irradiation in the Treatment of Tumors Involving the Bone. United States: N. p., 2009. Web. doi:10.1016/j.ijrobp.2008.03.074.
Wagner, Timothy D., Kobayashi, Wendy, Dean, Susan, Goldberg, Saveli I, Kirsch, David G, Suit, Herman D, Hornicek, Francis J, Pedlow, Francis X, Raskin, Kevin A, Springfield, Dempsey S, Yoon, Sam S, Gebhardt, Marc C, Mankin, Henry J, & DeLaney, Thomas F. Combination Short-Course Preoperative Irradiation, Surgical Resection, and Reduced-Field High-Dose Postoperative Irradiation in the Treatment of Tumors Involving the Bone. United States. https://doi.org/10.1016/j.ijrobp.2008.03.074
Wagner, Timothy D., Kobayashi, Wendy, Dean, Susan, Goldberg, Saveli I, Kirsch, David G, Suit, Herman D, Hornicek, Francis J, Pedlow, Francis X, Raskin, Kevin A, Springfield, Dempsey S, Yoon, Sam S, Gebhardt, Marc C, Mankin, Henry J, and DeLaney, Thomas F. 2009. "Combination Short-Course Preoperative Irradiation, Surgical Resection, and Reduced-Field High-Dose Postoperative Irradiation in the Treatment of Tumors Involving the Bone". United States. https://doi.org/10.1016/j.ijrobp.2008.03.074.
@article{osti_21172562,
title = {Combination Short-Course Preoperative Irradiation, Surgical Resection, and Reduced-Field High-Dose Postoperative Irradiation in the Treatment of Tumors Involving the Bone},
author = {Wagner, Timothy D. and Kobayashi, Wendy and Dean, Susan and Goldberg, Saveli I and Kirsch, David G and Suit, Herman D and Hornicek, Francis J and Pedlow, Francis X and Raskin, Kevin A and Springfield, Dempsey S and Yoon, Sam S and Gebhardt, Marc C and Mankin, Henry J and DeLaney, Thomas F},
abstractNote = {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.},
doi = {10.1016/j.ijrobp.2008.03.074},
url = {https://www.osti.gov/biblio/21172562}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 1,
volume = 73,
place = {United States},
year = {Thu Jan 01 00:00:00 EST 2009},
month = {Thu Jan 01 00:00:00 EST 2009}
}