title: Intraoperative radiotherapy in the multidisciplinary treatment of bone sarcomas in children and adolescents.
abstract: From September 1984 to December 1989, 38 patients of pediatric age with localized bone sarcomas received intraoperative radiotherapy (IORT) as part of a multidisciplinary treatment program. The age ranged from 6 to 21 years. The tumor histologies were 22 osteosarcomas and 16 Ewing's sarcomas. Thirty-four had initial primary disease (90%) and 4 were treated for local recurrence (10%). IORT was used on 32 untreated patients and in 6 previously treated with external beam radiotherapy (EBR). The IORT field included the surgically exposed tumor bed area. Single radiation doses ranging from 10 to 20 Gy were delivered, using 6-20 MeV electron beams. The median follow-up time for the entire group is 25 months (2-65+ months). The projected 5-year disease-free and overall survival rates are 65% and 69%, respectively. One patient developed a local recurrence in each histological group: one chondroblastic osteosarcoma and one cervical Ewing's sarcoma. Six patients died from metastatic progression: 3 initially recurrent tumors and three primary disease cases. Severe neuropathy and soft tissue necrosis were seen in some patients as IORT related complications. IORT is a feasible technique to be integrated in multidisciplinary programs that may promote local control in pediatric and adolescent patients with bone sarcomas. Peripheral nerves are dose-limiting tissue structures for IORT.
authors.affiliation: Department of Radiation Oncology, Clinica Universitaria de Navarra, Facultad de Medicina, Spain.
authors.forename: F A
authors.initials: FA
authors.lastname: Calvo
authors.forename: D
authors.initials: D
authors.lastname: Ortiz de Urbina
authors.forename: L
authors.initials: L
authors.lastname: Sierrasesúmaga
authors.forename: O
authors.initials: O
authors.lastname: Abuchaibe
authors.forename: I
authors.initials: I
authors.lastname: Azinovic
authors.forename: F
authors.initials: F
authors.lastname: Antillon
authors.forename: M
authors.initials: M
authors.lastname: Santos
authors.forename: J
authors.initials: J
authors.lastname: Cañadell
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D002648:Child; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D012516:Osteosarcoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D003609:Dactinomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin; D008727:Methotrexate