title: The megavoltage radiation therapy in treatment of patients with advanced or difficult giant cell tumors of bone.
abstract: OBJECTIVE
  To assess the outcomes of radiotherapy, in terms of local control and treatment complications, of advanced or difficult giant cell tumors of bone (GCTB) that could not be treated by surgery.
  
  
  METHODS
  Among 122 consecutive patients with confirmed GCTB from 1985 to 2007, 77 patients were treated by megavoltage radiotherapy because they were inappropriate candidates for surgery. We have performed analysis of all data in terms of progression-free survival (PFS) and treatment morbidity. Median follow-up time was 58 months.
  
  
  RESULTS
  In the irradiated group, maximal tumor size ranged from 5 to 18 cm (median, 8.5). Anatomic distribution was as follows: femur, 27 cases; tibia, 19; radial/ulnar bone, 12; sacrum, 9; pelvic bones, 5; other, 5. Twenty-one patients (27%) were referred for local recurrence after ≥1 other treatment procedures. The radiation doses ranged from 26 to 89 Gy (median, 56; administered 1.8-2.0 Gy/fraction with average total duration of treatment of 5-7 weeks); 8 patients (10%) received <50 Gy. All patients tolerated treatment well without acute or late complications. All patients except two are alive. Local control was achieved in 65 patients (84%; bone recalcification/restitution of joint functions), 12 patients showed signs of local progression, all within irradiated fields (9 were treated successfully with salvage surgery). Five- and 10-year local PFS were 83% and 73%, respectively. Three patients developed lungs metastases. Malignant transformation of GCTB occurred in two patients.
  
  
  CONCLUSIONS
  GCTB can be safely and effectively treated with megavoltage radiotherapy with local control rate >80% at 5 years. Our study confirms that radiotherapy of GCTB offers an alternative to difficult or complex surgery and may be an option of choice in the treatment of inoperable patients.
authors.affiliation: Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland.
authors.forename: Wlodzimierz
authors.initials: W
authors.lastname: Ruka
authors.forename: Piotr
authors.initials: P
authors.lastname: Rutkowski
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Morysiński
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Nowecki
authors.forename: Marcin
authors.initials: M
authors.lastname: Zdzienicki
authors.forename: Donata
authors.initials: D
authors.lastname: Makula
authors.forename: Konrad
authors.initials: K
authors.lastname: Ptaszyński
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Bylina
authors.forename: Urszula
authors.initials: U
authors.lastname: Grzesiakowska
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult