title: Definitive intraoperative very high-dose radiotherapy for localized osteosarcoma in the extremities.
abstract: OBJECTIVE
  To evaluate the outcome and adverse effects in patients with osteosarcoma treated with very high-dose definitive intraoperative radiotherapy (IORT), with the intention of saving the affected limb.
  
  
  METHODS
  Thirty-nine patients with osteosarcoma in their extremities were treated with definitive IORT. The irradiation field included the tumor plus an adequate wide margin and excluded the major vessels and nerves. Forty-five to 80 Gy of electrons or X-rays were delivered. The median follow-up of the surviving patients was 124 months.
  
  
  RESULTS
  The cause-specific and relapse-free 5-year survival rate was 50% and 43%, respectively. Distant metastasis developed in 23 patients; 19 died and 4 were alive for >10 years. Nine local recurrences were found 4-29 months after IORT in the affected limb. No radiation-induced skin reaction or nerve palsy was observed in the patients treated with X-rays. Experiments using phantoms also confirmed that the scatter dose was below the toxic level in the IORT setting with X-rays.
  
  
  CONCLUSIONS
  Very high-dose definitive IORT combined with preventive nailing and chemotherapy appeared to be a promising quality-of-life-oriented alternative to treating patients with osteosarcomas in the extremities, although the problem of recurrences from the surrounding unirradiated soft tissue remains to be solved.
authors.affiliation: Department of Radiology, Kyoto University, Faculty of Medicine, Sakyo-ku, Kyoto, Japan. oya@kuhp.kyoto-u.ac.jp
authors.forename: N
authors.initials: N
authors.lastname: Oya
authors.forename: M
authors.initials: M
authors.lastname: Kokubo
authors.forename: T
authors.initials: T
authors.lastname: Mizowaki
authors.forename: Y
authors.initials: Y
authors.lastname: Shibamoto
authors.forename: Y
authors.initials: Y
authors.lastname: Nagata
authors.forename: K
authors.initials: K
authors.lastname: Sasai
authors.forename: Y
authors.initials: Y
authors.lastname: Nishimura
authors.forename: T
authors.initials: T
authors.lastname: Tsuboyama
authors.forename: J
authors.initials: J
authors.lastname: Toguchida
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.forename: M
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D003131:Combined Modality Therapy; D005121:Extremities; D005260:Female; D005266:Femoral Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D006811:Humerus; D007085:Ilium; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D013977:Tibia; D016896:Treatment Outcome