Outcomes for pediatric patients with osteosarcoma treated with palliative radiotherapy

Abstract

Background Few studies have addressed the efficacy of palliative radiotherapy (RT) for pediatric osteosarcoma (OS), a disease generally considered to be radioresistant. We describe symptom relief, local control, and toxicity associated with palliative RT among children with OS. Procedure Patients diagnosed with OS at age 18 and under and treated with RT for palliation of symptomatic metastases or local recurrence at the primary site from 1997 to 2017 were included. We retrospectively reviewed details of RT, symptom improvement, local control, survival, and toxicity. Results Thirty‐two courses of palliative RT were given to 20 patients with symptomatic metastatic and/or locally recurrent primary disease. The median equivalent dose in 2 Gy fractions (EQD2) was 40.0 Gy (range, 20.0–60.4). The median number of fractions per course was 15 (range, 5–39). Symptom improvement occurred in 24 (75%) courses of RT at a median time of 15.5 days (range, 3–43). In nine courses (37.5%), symptoms recurred after a median duration of symptom relief of 140 days (range, 1–882). Higher EQD2 correlated with longer duration of response (r = 0.39, P = 0.0003). Imaging revealed local failure in 3 of 14 courses followed with surveillance imaging studies (21.4%). The median time to progression was 12.9 months (range, 4.4–21.8). The median follow‐up time following the first course of palliative RT was 17.5 months (range, 1.74–102.24), and median time to overall survival was 19.4 months. Toxicity was mild, with grade 2 toxicity occurring in one course (3.1%). Conclusions RT is an effective method of symptom palliation for patients with recurrent or metastatic OS, with higher delivered dose correlating with longer symptom relief and with little associated toxicity.

Understanding and Modeling Metastasis Biology to Improve Therapeutic Strategies for Combating Osteosarcoma Progression

“…Although these therapies do little to effect long-term outcomes, they can facilitate short-term disease control and prolong survival. While radiation has a relatively minor role in the curative care of patients with either localized or metastatic disease, modern techniques can be extremely helpful in the palliative setting, providing excellent disease and symptom control (194). The only intervention proven to offer hope for long-term "cure" of disease in patients with metastases remains surgical excision of all macrometastases, and several studies suggest that up to 30% of patients who achieve complete surgical remission will survive disease-free beyond 5 years (195)(196)(197).…”

223-Radium for metastatic osteosarcoma: combination therapy with other agents and external beam radiotherapy

“…3 Major problems affecting osteosarcoma survival and quality of life (QOL) after initial treatment are the development of lung and bone metastases. [16][17][18][19] We have used additional agents with 223-radium as well as palliative and/or stereotactic body radiotherapy (SBRT) as clinically indicated against metastatic osteosarcoma because patients with osteosarcoma with bone metastases have worse survival and are at risk of skeletal complications, [20][21][22] can escape from radiopharmaceutical action by metastases that do not avidly make bone and may develop pain from metastases that incompletely respond to alpha radiotherapy. We report that combination therapy is feasible and can result in clinical benefit.…”

Treatment paradigms for oligometastatic pediatric cancers: a narrative review with a focus on radiotherapy approaches

“…In addition to pain, palliative RT can also help ameliorate dyspnea and neurologic symptoms. Retrospective data from Stanford reports favorable symptom relief, local control and toxicity outcomes after conventional dose-escalated palliative RT for metastatic and recurrent pediatric osteosarcoma (55). Twenty pediatric patients, median age of 17.9 years (range, 6.3-34.8), with symptomatic metastatic or locally recurrent disease were treated with 32 courses of palliative RT.…”