Stereotactic radiosurgery, a potential alternative treatment for pulmonary metastases from osteosarcoma

Abstract

Stereotactic radiosurgery (SRS), such as body gamma knife, was reported to achieve excellent rates of local disease control with limited toxicity in many cases of primary or secondary pulmonary tumor, except osteosarcoma. To confirm the value of SRS in pulmonary metastases from osteosarcoma, we reviewed the experience from our institution (Department of Oncology, Affiliated Sixth People’s Hospital, Shanghai) and compared the efficiency of SRS with that of surgical resection. From January 2005 to December 2012, we carried out a retrospective investigation of 58 patients (age, 8–59 years; mean, 25.2 years) who were diagnosed with non-metastatic osteosarcoma of the extremity and later developed pulmonary metastasis during the period of adjuvant chemotherapy or follow-up. Among them, 27 patients were treated by SRS using the body gamma-knife system. A total dose of 50 Gy was delivered at 5 Gy/fraction to the 50% isodose line covering the planning target volume, whereas a total dose of 70 Gy was delivered at 7 Gy/fraction to the gross target volume. The other 31 patients were treated by surgical resection. Two-year progression-free survival rate, two-year survival rate, median time of PRPFS (post-relapse progress-free survival) and PROS (post-relapse overall survival) in SRS group were parallel to that in surgical group. All 27 patients tolerated gamma knife radiosurgery well while only 9 patients had grades 1–2 pneumonitis. We believe SRS, compared with surgical resection, is effective and safe in treating pulmonary metastasis from osteosarcoma, especially for those patients who were medically unfit for a resection or who refused surgery.

Treatment of Sarcoma Lung Metastases with Stereotactic Body Radiotherapy

“…We believe this report constitutes the largest cohort of sarcoma patients treated with SBRT that exists in the literature to date. More importantly, our results are commensurate with those previously published in similar patient populations [ 14 – 16 , 26 , 27 ] ( Table 5 ).…”

Stereotactic Body Radiation Therapy for Pulmonary Oligometastases Arising from Non-lung Primaries in Patients Without Extrapulmonary Disease

“…At the moment, however, it is difficult to adequately assess the survival outcomes of patients with pulmonary metastases treated with SBRT, especially compared to surgical resection, as there are a paucity of randomized clinical trials addressing this topic and the data that is available from phase I/II trials encompass a diverse patient population [ 7 , 15 ]. There has been one retrospective series that compared SBRT to metastasectomy that illustrated equivalency; however, they focused on patients with osteosarcoma [ 16 ]. Further complicating appropriate comparisons are the patient populations themselves, as patients receiving radiation frequently are not surgical candidates due to significant comorbidities.…”

Silencing LPAATβ inhibits tumor growth of cisplatin-resistant human osteosarcoma in vivo and in vitro

“…Osteosarcoma is the most common primary malignant tumor that arises from osteoid tissues in young adults and adoles-cents (1,2). Most patients with osteosarcoma are diagnosed at a late stage with strong requirement of surgical radiotherapy or adjuvant chemotherapy, however, usually it is not effective (3,4). Since platinum-based drugs such as cisplatin are the standard first-line agents used alone or in combination with other drugs for osteosarcoma treatment, osteosarcoma cells may acquire resistance to cisplatin with tumor recurrence through the expansion of cisplatin-resistance cell population (5,6).…”