title: Adjuvant radiation therapy in resected high-grade localized skeletal osteosarcomas treated with neoadjuvant chemotherapy: Long-term outcomes.
abstract: To assess long-term outcomes and toxicity of adjuvant radiotherapy in the post-surgical management of patients with resected high-grade skeletal osteosarcomas.
  
  
  
  Seventy-two patients with primary resected osteosarcomas underwent adjuvant radiotherapy after neoadjuvant chemotherapy from December 1984 to December 2008. Local control (LC), overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier methods. For survival outcomes potential associations were assessed in univariate and multivariate analyses using the Cox proportional hazards model.
  
  
  
  After a median follow-up of 174months (range, 33-363months), 10-year LC, DFS, and OS rates were 82%, 58%, and 73%, respectively. In the multivariate analysis only R1 margin status (p=0.02) remained significantly associated with LC. Patients with tumor necrosis <90% (p=0.04) and R1 resection margin (p=0.05) remained at a significantly higher risk of mortality on multivariate analysis. Six patients (8%) developed grade ⩾3 treatment-related chronic toxicity events. No grade 5 toxicities were reported.
  
  
  
  A multimodal radiotherapy-containing approach is a well-tolerated component of treatment for patients with osteosarcomas undergoing programed resection, allowing low toxicity rates while maintaining high local control rates.
authors.affiliation: Department of Radiation Oncology, Clinica Instituto de Radiomedicina (IRAM), Santiago, Chile. Electronic address: cvsolep@iram.cl.
authors.forename: Claudio V
authors.initials: CV
authors.lastname: Sole
authors.affiliation: Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Calvo
authors.affiliation: Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Alvarez
authors.affiliation: Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cambeiro
authors.affiliation: Service of Orthopedic Surgery and Traumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Cuervo
authors.affiliation: Service of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Mikel
authors.initials: M
authors.lastname: San Julian
authors.affiliation: Department of Radiation Oncology, Clinica Instituto de Radiomedicina (IRAM), Santiago, Chile; Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Sole
authors.affiliation: Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Martinez-Monge
authors.affiliation: Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Sierrasesumaga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods*; D012516:Osteosarcoma / Q000188:drug therapy* / Q000532:radiotherapy*; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Local control; Osteosarcomas; Radiotherapy