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.
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.
Authors: I Frank Ciernik; Andrzej Niemierko; David C Harmon; Wendy Kobayashi; Yen-Lin Chen; Torunn I Yock; David H Ebb; Edwin Choy; Kevin A Raskin; Norbert Liebsch; Francis J Hornicek; Thomas F Delaney Journal: Cancer Date: 2011-03-29 Impact factor: 6.860
Authors: Maximilian Rudert; Cornelia Winkler; Boris Michael Holzapfel; Hans Rechl; Peter Kneschaurek; Reiner Gradinger; Michael Molls; Barbara Röper Journal: Strahlenther Onkol Date: 2010-03-26 Impact factor: 3.621
Authors: Aashish D Bhatt; Alex Jacobson; Richard Y Lee; Christine Giraud; Joseph H Schwab; Francis J Hornicek; Petur Nielsen; Edwin Choy; David Harmon; Thomas F DeLaney; Yen-Lin E Chen Journal: Int J Part Ther Date: 2017-03-14
Authors: Jantine PosthumaDeBoer; Thomas Würdinger; Harm C A Graat; Victor W van Beusechem; Marco N Helder; Barend J van Royen; Gertjan J L Kaspers Journal: BMC Cancer Date: 2011-04-29 Impact factor: 4.430
Authors: Sara R Martins-Neves; Áurio O Lopes; Anália do Carmo; Artur A Paiva; Paulo C Simões; Antero J Abrunhosa; Célia M F Gomes Journal: BMC Cancer Date: 2012-04-04 Impact factor: 4.430