Abstract
BackgroundUnresectable pediatric osteosarcoma has poor outcomes with conventional treatments.ResultsTwenty-six patients aged 11–20 years (median 16) had inoperable osteosarcoma of the trunk (24 pelvic, 1 mediastinal and 1 paravertebral) without any other lesion at initial examination. There were 22 primary, 1 locally recurrent and 3 metastatic cases. Median CIRT dose was 70.4 Gy RBE (relative biological effectiveness) delivered in 16 fractions. Median follow-up was 32.7 months. Overall survival was 50.0% and 41.7% at 3 and 5 years, respectively. Ten patients survived for more than 5 years (range 5–20.7 years). Local control was 69.9% and 62.9% at 3 and 5 years, respectively and progression-free survival was 34.6% at 3 and 5 years. Only largest tumor diameter correlated with 5-year overall survival and local control. There were 4 grade 3-4 CIRT-related late toxicities, 1 case of bone fracture and no treatment-related mortalities. All patients (except 1) were able to ambulate after CIRT.ConclusionsCIRT was safe and efficacious in the treatment of inoperable pediatric osteosarcoma with improved local control and overall survival compared to conventional treatments.MethodsWe retrospectively reviewed the records of pediatric and adolescent patients who received carbon ion radiotherapy (CIRT) for inoperable osteosarcoma between 1996 and 2014.
Highlights
Osteosarcoma, the most common primary bone malignancy in children and adolescents, is a rare radio-resistant cancer [1]
carbon ion radiotherapy (CIRT) was safe and efficacious in the treatment of inoperable pediatric osteosarcoma with improved local control and overall survival compared to conventional treatments
Between November 1996 and July 2014, 26 pediatric and adolescent patients with unresectable, truncal, and histologically proven osteosarcomas were treated with CIRT
Summary
Osteosarcoma, the most common primary bone malignancy in children and adolescents, is a rare radio-resistant cancer [1]. Neoadjuvant chemotherapy, followed by surgical resection, and further adjuvant chemotherapy is the typical treatment approach for highgrade osteosarcomas [2]. While this approach yields an acceptable overall survival for resectable cases, outcomes remain poor for unresectable osteosarcomas such as those in the pelvis or trunk. These cases only account for a fraction of all osteosarcomas [3,4,5]. Data on the treatment of unresectable osteosarcoma cases in pediatric and adolescent patients is limited.
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