Carbon ion radiotherapy for inoperable pediatric osteosarcoma

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.

Carbon Ion Therapy: A Modern Review of an Emerging Technology

“…A promising LC was also reported, at 62.9% at 5 years, with four patients developing grade 3 or higher late toxicities. Only one patient was unable to ambulate after treatment (103).…”

Pretreatment C-reactive protein and neutrophil counts as a predictor of metastasis in patients with osteosarcoma

“…In our study, the patients with a higher NC underwent radiotherapy more often than those with a lower NC, instead of surgery, although the rate of chemotherapy in the patients with a lower NC was the same as in those with a higher NC. Recently, radiotherapy, especially carbon ion radiotherapy has been reported to be as effective as surgical treatment [41][42][43]. Therefore, treatment methods do not markedly in uence the occurrence of metastasis.…”

Radiotherapy Advances in Pediatric Neuro-Oncology

“…These properties suggest that heavy ion therapy may be particularly helpful for radioresistant tumors, such as osteosarcoma (the most common pediatric bone tumor). Early data utilizing definitive heavy ion therapy for unresectable pediatric osteosarcoma are promising [79,80,81], and future studies exploring the role of heavy ion therapy in the treatment of pediatric patients are underway.…”