A case of radiation-induced osteosarcoma treated effectively by boron neutron capture therapy

Abstract

We treated a 54-year-old Japanese female with a recurrent radiation-induced osteosarcoma arising from left occipital skull, by reactor-based boron neutron capture therapy (BNCT). Her tumor grew rapidly with subcutaneous and epidural extension. She eventually could not walk because of cerebellar ataxia. The tumor was inoperable and radioresistant. BNCT showed a marked initial therapeutic effect: the subcutaneous/epidural tumor reduced without radiation damage of the scalp except hair loss and the patient could walk again only 3 weeks after BNCT. BNCT seems to be a safe and very effective modality in the management of radiation-induced osteosarcomas that are not eligible for operation and other treatment modalities.

Understanding the potentiality of accelerator based-boron neutron capture therapy for osteosarcoma: dosimetry assessment based on the reported clinical experience

“…This kind of analysis was performed in three rats showing vital tumour, and selecting the areas where the osteosarcoma was not necrotic nor characterized by haemorrhage, the average value found was 64 +/−18 ppm. These results, although not constituting a complete boron bio-distribution study in osteosarcoma and despite the unevenness of concentration measured in the tumour area due to the heterogeneity of tissues, nevertheless show that it is possible to obtain a boron concentration ratio comparable to 3.5, obtained in clinical BNCT and in other animal studies [ 19 , 20 ]. Basing on these results, we chose a representative value in tumour of 60 ppm for the treatment planning simulations.…”

“…In particular, the most severe adverse effects were observed in the skin of the foot, an anatomic area that in case of osteosarcoma would be spared from irradiation. Also in the case of BNCT for skull osteosarcoma no radiation injury of the scalp was caused, the only adverse effect being hair loss in neutron field [ 20 ]. This experience also gives information about possible effects in normal bone: in this case dose was limited to the normal brain, but thanks to the tumour-to-normal bone boron concentration ratio, the skull was not damaged.…”

“…To understand whether the dosimetry obtained was potentially therapeutic, the simulated treatment was compared with a case of osteosarcoma treated by BNCT at KURRI in Japan [ 20 ]. The patient was a 54-year-old Japanese female with recurrent radiation-induced osteosarcoma of the skull (tumour volume 169 cm 3 ).…”

“…BNCT has been clinically applied for the first time in Japan in two cases: a recurrent maxilliary sarcoma (fibroblastic osteosarcoma) [ 19 ] and a skull radio-induced osteosarcoma [ 20 ]. The latter treatment ensured a stable local control of the tumour that did not show any recurrence for 17 months, and the overall status of the patient markedly improved already few days after the treatment.…”

Effect of low- and high-linear energy transfer radiation on in vitro and orthotopic in vivo models of osteosarcoma by activation of caspase-3 and -9

“…As compared to conventional approaches, carbon ion high-LET radiotherapy is highly efficacious in treating deep-seated malignant OSs ( 14 , 15 ). In addition, boron neutron capture therapy (BNCT) has been used to successfully treat a patient with recurrent radiation-induced OS ( 16 ). However, the molecular mechanisms underlying carbon ion- or neutron-induced OS cytotoxicity are largely unknown.…”