Adjuvant radiation therapy in resected high-grade localized skeletal osteosarcomas treated with neoadjuvant chemotherapy: Long-term outcomes
Sole CV (1), Calvo FA (2), Alvarez E (3), Cambeiro M (4), Cuervo M (5), San Julian M (6), Sole S (7), Martinez-Monge R (4), Sierrasesumaga L (8).
(1) Department of Radiation Oncology, Clinica Instituto de Radiomedicina (IRAM), Santiago, Chile. Electronic address: email@example.com.
(2) Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain.
(3) Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
(4) Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain.
(5) Service of Orthopedic Surgery and Traumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
(6) Service of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain.
(7) Department of Radiation Oncology, Clinica Instituto de Radiomedicina (IRAM), Santiago, Chile; Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.
(8) Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain.
To assess long-term outcomes and toxicity of adjuvant radiotherapy in the post-surgical management of patients with resected high-grade skeletal osteosarcomas.
METHODS AND MATERIALS
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.
CITATION Radiother Oncol. 2016 Mar 9. pii: S0167-8140(16)00117-1. doi: 10.1016/j.radonc.2016.02.029