Combination short-course preoperative irradiation, surgical resection, and reduced-field high-dose postoperative irradiation in the treatment of tumors involving the bone.
OBJECTIVE
To assess the feasibility and outcomes of combination short-course preoperative radiation, resection, and reduced-field (tumor bed without operative field coverage) high-dose postoperative radiation for patients with solid tumors mainly involving the spine and pelvis.


METHODS
Between 1982 and 2006, a total of 48 patients were treated using this treatment strategy for solid tumors involving bone. Radiation treatments used both photons and protons.


RESULTS
Of those treated, 52% had chordoma, 31% had chondrosarcoma, 8% had osteosarcoma, and 4% had Ewing's sarcoma, with 71% involving the pelvis/sacrum and 21% elsewhere in the spine. Median preoperative dose was 20 Gy, with a median of 50.4 Gy postoperatively. With 31.8-month median follow-up, the 5-year overall survival (OS) rate is 65%; 5-year disease-free survival (DFS) rate, 53.8%; and 5-year local control (LC) rate, 72%. There were no significant differences in OS, DFS, and LC according to histologic characteristics. Between primary and recurrent disease, there was no significant difference in OS rates (74.4% vs. 51.4%, respectively; p = 0.128), in contrast to DFS (71.5% vs. 18.3%; p = 0.0014) and LC rates (88.9% vs. 30.9%; p = 0.0011) favoring primary disease. After resection, 10 patients experienced delayed wound healing that did not significantly impact on OS, DFS, or LC.


CONCLUSIONS
This approach is promising for patients with bone sarcomas in which resection will likely yield close/positive margins. It appears to inhibit tumor seeding with an acceptable rate of wound-healing complications. Dose escalation is accomplished without high-dose preoperative radiation (likely associated with higher rates of acute wound healing delays) or large-field postoperative radiation only (likely associated with late normal tissue toxicity). The LC and DFS rates are substantially better for patients with primary than recurrent sarcomas.
Wagner
Timothy D
TD
Department of Radiation Oncology, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
Kobayashi
Wendy
W
Dean
Susan
S
Goldberg
Saveli I
SI
Kirsch
David G
DG
Suit
Herman D
HD
Hornicek
Francis J
FJ
Pedlow
Francis X
FX
Raskin
Kevin A
KA
Springfield
Dempsey S
DS
Yoon
Sam S
SS
Gebhardt
Marc C
MC
Mankin
Henry J
HJ
Delaney
Thomas F
TF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000628:therapy*; D002648:Child; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult