Stereotactic Body Radiotherapy for Metastatic and Recurrent Ewing Sarcoma and Osteosarcoma

Abstract

Background. Radiotherapy has been utilized for metastatic and recurrent osteosarcoma and Ewing sarcoma (ES), in order to provide palliation and possibly prolong overall or progression-free survival. Stereotactic body radiotherapy (SBRT) is convenient for patients and offers the possibility of increased efficacy. We report our early institutional experience using SBRT for recurrent and metastatic osteosarcoma and Ewing sarcoma. Methods. We reviewed all cases of osteosarcoma or ES treated with SBRT between 2008 and 2012. Results. We identified 14 patients with a total of 27 lesions from osteosarcoma (n = 19) or ES (n = 8). The median total curative/definitive SBRT dose delivered was 40 Gy in 5 fractions (range, 30–60 Gy in 3–10 fractions). The median total palliative SBRT dose delivered was 40 Gy in 5 fractions (range, 16–50 Gy in 1–10 fractions). Two grade 2 and 1 grade 3 late toxicities occurred, consisting of myonecrosis, avascular necrosis with pathologic fracture, and sacral plexopathy. Toxicity was seen in the settings of concurrent chemotherapy and reirradiation. Conclusions. This descriptive report suggests that SBRT may be a feasible local treatment option for patients with osteosarcoma and ES. However, significant toxicity can result, and thus systematic study is warranted to clarify efficacy and characterize long-term toxicity.

Treatment pathway of bone sarcoma in children, adolescents, and young adults

“…Higher total radiation doses or hypofractionation (larger daily doses) may improve local control. Stereotactic radiosurgery may allow shorter courses of treatment while still providing durable local control …”

“…Patients with local recurrences also tend to fare better than those with systemic or combined recurrences, particularly if further local therapy can be administered in addition to chemotherapy. In patients with metastatic or recurrent disease with better long‐term prognoses, stereotactic body radiotherapy may offer a quicker treatment course that provides durable local control …”

Short‐Interval Retreatment With Stereotactic Body Radiotherapy (SBRT) for Pediatric Neuroblastoma Resulting in Severe Myositis

“…The sole series reporting toxicity after SBRT in pediatric tumors involved 14 children and young adults with metastatic or recurrent Ewing sarcoma or osteosarcoma. [13] Two-year local control was 85%. A 17-year-old patient experienced Grade II myositis in the right iliac wing 2 months after 50 Gy in five fractions of SBRT and concurrent chemotherapy.…”

“…SBRT in pediatrics is limited given concerns for significant early toxicity and potential late effects. The sole series reporting toxicity after SBRT in pediatric tumors involved 14 children and young adults with metastatic or recurrent Ewing sarcoma or osteosarcoma . Two‐year local control was 85%.…”

Stereotactic body radiotherapy for pediatric hepatocellular carcinoma with central biliary obstruction

“…This therapeutic modality can serve as a bridge to downstage and control disease for possible future liver transplant. However, given the unknown potential late toxicities and lack of long‐term follow‐up, the use of SBRT in pediatric patients is largely confined to clinical trials at this time, though case reports and small series have indicated promising results in a handful of children treated with SBRT to extracranial sites . Of note, stereotactic radiosurgery that uses similarly ablative doses is used routinely for benign intracranial lesions in children, such as arteriovenous malformations, as well as in the setting of recurrent malignant disease in the brain and spine, and is well tolerated …”