Intraoperative radiotherapy in the multidisciplinary treatment of bone sarcomas in children and adolescents

Abstract

From September 1984 to December 1989, 38 patients of pediatric age with localized bone sarcomas received intraoperative radiotherapy (IORT) as part of a multidisci plinary treatment program. The age ranged from 6 to 21 years. The tumor histologies were 22 osteosarcomas and 16 Ewing's sarcomas.Thirty‐four had initial primary disease (90%) and 4 were treated for local recurrence (10%). IORT was used on 32 untreated patients and in 6 previously treated with external beam radiotherapy (EBR). The IORT field included the surgically exposed tumor bed area. Single radiation doses ranging from 10 to 20 Gy were delivered, using 6–20 MeV electron beams. The median follow‐up time for the entire group is 25 months (2–65+ months). The projected 5‐year disease‐free and overall survival rates are 65% and 69%, respectively. One patient developed a local recurrence in each histological group: one chondroblastic osteosarcoma and one cervical Ewing's sarcoma. Six patients died from metastatic progression: 3 initially recurrent tumors and three primary disease cases. Severe neuropathy and soft tissue necrosis were seen in some patients as IORT related complications.IORT is a feasible technique to be integrated in multidisciplinary programs that may promote local control in pediatric and adolescent patients with bone sarcomas. Peripheral nerves are dose‐limiting tissue structures for IORT.

Intraoperative radiation therapy

“…In bone sarcomas (both Ewing and osteosarcoma) IORT containing multimodal treatment was able to promote high LC rates (95%) together with extremity preservation surgical management [69]. Three different approaches have been used: definitive IORT without resection [70]; definitive IORT with resection [71], and intraoperative extracorporeal irradiation and reimplantation of malignant bone tumour [72].…”

Intraoperative radiation therapy for advanced neuroblastoma: the problem of securing the IORT field

“…In intraoperative radiation therapy (IORT) a high single radiation dose is delivered to the tumor site with protection of normal uninvolved organs and tissues [1][2][3][4][5][6]. Neuroblastoma is the most common solid tumor in childhood [7].…”

Feasibility of intraoperative electron beam radiation therapy in the treatment of locally advanced pediatric malignancies

“…IO electron RT is a sophisticated boosting technique that has been used infrequently in pediatric patients [3][4][5]. The patients treated in the current study provided valuable insight into the usefulness of IO electron RT in specific clinical situations.…”

“…The radiobiology of a single large radiation dose does not permit recovery of sublethally damaged cells or the reoxygenation of hypoxic cells. Neuropathies, sometimes severe, have been reported after large doses of IO electron RT [4][5][6]. Furthermore, there are sites in children that are not accessible to the electron beam applicator.…”