Background High-grade osteosarcoma is a primary malignant bone tumour mainly affecting children and young adults. The European and American Osteosarcoma Study (EURAMOS)-1 is a collaboration of four study groups aiming to improve outcomes of this rare disease by facilitating randomised controlled trials. Methods Patients eligible for EURAMOS-1 were aged ≤40 years with M0 or M1 skeletal high-grade osteosarcoma in which case complete surgical resection at all sites was deemed to be possible. A three-drug combination with methotrexate, doxorubicin and cisplatin was defined as standard chemotherapy, and between April 2005 and June 2011, 2260 patients were registered. We report survival outcomes and prognostic factors in the full cohort of registered patients. Results For all registered patients at a median follow-up of 54 months (interquartile range: 38–73) from biopsy, 3-year and 5-year event-free survival were 59% (95% confidence interval [CI]: 57–61%) and 54% (95% CI: 52–56%), respectively. Multivariate analyses showed that the most adverse factors at diagnosis were pulmonary metastases (hazard ratio [HR] = 2.34, 95% CI: 1.95–2.81), non-pulmonary metastases (HR = 1.94, 95% CI: 1.38–2.73) or an axial skeleton tumour site (HR = 1.53, 95% CI: 1.10–2.13). The histological subtypes telangiectatic (HR = 0.52, 95% CI: 0.33–0.80) and unspecified conventional (HR = 0.67, 95% CI: 0.52–0.88) were associated with a favourable prognosis compared with chondroblastic subtype. The 3-year and 5-year overall survival from biopsy were 79% (95% CI: 77–81%) and 71% (95% CI: 68–73%), respectively. For patients with localised disease at presentation and in complete remission after surgery, having a poor histological response was associated with worse outcome after surgery (HR = 2.13, 95% CI: 1.76–2.58). In radically operated patients, there was no good evidence that axial tumour site was associated with worse outcome. Conclusions In conclusion, data from >2000 patients registered to EURAMOS-1 demonstrated survival rates in concordance with institution- or group-level osteosarcoma trials. Further efforts are required to drive improvements for patients who can be identified to be at higher risk of adverse outcome. This trial reaffirms known prognostic factors, and owing to the large numbers of patients registered, it sheds light on some additional factors to consider.

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Since the end of 1996, we have treated more than 160 patients at PSI using spot-scanned protons. The range of indications treated has been quite wide and includes, in the head region, base-of-skull sarcomas, low-grade gliomas, meningiomas, and para-nasal sinus tumors. In addition, we have treated bone sarcomas in the neck and trunk--mainly in the sacral area--as well as prostate cases and some soft tissue sarcomas. PTV volumes for our treated cases are in the range 20-4500 ml, indicating the flexibility of the spot scanning system for treating lesions of all types and sizes. The number of fields per applied plan ranges from between 1 and 4, with a mean of just under 3 beams per plan, and the number of fluence modulated Bragg peaks delivered per field has ranged from 200 to 45 000. With the current delivery rate of roughly 3000 Bragg peaks per minute, this translates into delivery times per field of between a few seconds to 20-25 min. Bragg peak weight analysis of these spots has shown that over all fields, only about 10% of delivered spots have a weight of more than 10% of the maximum in any given field, indicating that there is some scope for optimizing the number of spots delivered per field. Field specific dosimetry shows that these treatments can be delivered accurately and precisely to within +/-1 mm (1 SD) orthogonal to the field direction and to within 1.5 mm in range. With our current delivery system the mean widths of delivered pencil beams at the Bragg peak is about 8 mm (sigma) for all energies, indicating that this is an area where some improvements can be made. In addition, an analysis of the spot weights and energies of individual Bragg peaks shows a relatively broad spread of low and high weighted Bragg peaks over all energy steps, indicating that there is at best only a limited relationship between pencil beam weighting and depth of penetration. This latter observation may have some consequences when considering strategies for fast re-scanning on second generation scanning gantries.

Chordomas are rare, malignant bone tumors of the skull-base and axial skeleton. Until recently, there was no consensus among experts regarding appropriate clinical management of chordoma, resulting in inconsistent care and suboptimal outcomes for many patients. To address this shortcoming, the European Society of Medical Oncology (ESMO) and the Chordoma Foundation, the global chordoma patient advocacy group, convened a multi-disciplinary group of chordoma specialists to define by consensus evidence-based best practices for the optimal approach to chordoma. In January 2015, the first recommendations of this group were published, covering the management of primary and metastatic chordomas. Additional evidence and further discussion were needed to develop recommendations about the management of local-regional failures. Thus, ESMO and CF convened a second consensus group meeting in November 2015 to address the treatment of locally relapsed chordoma. This meeting involved over 60 specialists from Europe, the United States and Japan with expertise in treatment of patients with chordoma. The consensus achieved during that meeting is the subject of the present publication and complements the recommendations of the first position paper.

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Monte Carlo (MC) calculations are a fundamental tool for the investigation of ionization chambers (ICs) in radiation fields, and for calculations in the scope of IC reference dosimetry. Geant4, as used for the toolkit TOPAS, is a major general purpose code, generally suitable for investigating ICs in primary proton beams. To provide reliable results, the impact of parameter settings and the limitations of the underlying condensed history (CH) algorithm need to be known. A Fano cavity test was implemented in Geant4 (10.03.p1) for protons, based on the existing version for electrons distributed with the Geant4 release. This self-consistent test allows the calculation to be compared with the expected result for the typical IC-like geometry of an air-filled cavity surrounded by a higher density material. Various user-selectable parameters of the CH implementation in the EMStandardOpt4 physics-list were tested for incident proton energies between 30 and 250 MeV. Using TOPAS (3.1.p1) the influence of production cuts was investigated for bare air-cavities in water, irradiated by primary protons. Detailed IC geometries for an NACP-02 plane-parallel chamber and an NE2571 Farmer-chamber were created. The overall factor f as a ratio between the dose-to-water and dose to the sensitive air-volume was calculated for incident proton energies between 70 and 250 MeV. The Fano test demonstrated the EMStandardOpt4 physics-list with the WentzelIV multiple scattering model as appropriate for IC calculations. If protons start perpendicular to the air cavity, no further step-size limitations are required to pass the test within 0.1%. For an isotropic source, limitations of the maximum step length within the air cavity and its surrounding as well as a limitation of the maximum fractional energy loss per step were required to pass within 0.2%. A production cut of  ⩽5 μm or  ∼15 keV for all particles yielded a constant result for f of bare air-filled cavities. The overall factor f for the detailed NACP-02 and NE2571 chamber models calculated with TOPAS agreed with the values of Gomà et al (2016 Phys. Med. Biol. 61 2389) within statistical uncertainties (1σ) of<0.3% for almost all energies with a maximum deviation of 0.6% at 250 MeV for the NE2571. The selection of hadronic scattering models (QGSP_BIC versus QGSP_BERT) in TOPAS impacted the results at the highest energies by 0.3%  ±  0.1%. Based on the Fano cavity test, the Geant4/TOPAS Monte Carlo code, in its investigated version, can provide reliable results for IC calculations. Agreement with the detailed IC models and the published values of Gomà et al can be achieved when production cuts are reduced from the TOPAS default values. The calculations confirm the reported agreement of Gomà et al for [Formula: see text] with IAEA-TRS398 values within the given uncertainties. An additional uncertainty for the MC-calculated [Formula: see text] of  ∼0.3% by hadronic interaction models should be considered.