Multimodality treatment of osteosarcoma: Radiation in a high‐risk cohort

<jats:title>Abstract</jats:title><jats:sec><jats:title>Purpose</jats:title><jats:p>Chemotherapy during radiation and/or bone‐seeking radioisotope therapy (153‐samarium; 1 mCi/kg) during radiation may improve osteosarcoma cancer control.</jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p>We analyzed our preliminary radiation experience in high‐risk, metastatic, and/or recurrent patients during a consecutive period of 20 months (May 2005–December 2006).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Thirty‐nine high‐risk osteosarcoma patients had radiotherapy; 119 sites were irradiated. A median four sites were irradiated per patient (range 1–14). The median radiation dose and number of fractions of radiation was 30 Gy in 10 fractions (range 10–70 Gy in 4–35 fractions). Chemotherapy, most commonly ifosfamide or methotrexate, was used in 80% (100/119) radiotherapy courses. Of 38 painful sites, 29 had improvement (76%), 4 had no change (10%), and 5 had more pain (13%). Objective and potentially durable responses were documented using PET‐CT and bone scans with persistent and sustained reduction of standard uptake values (SUVs; initial SUV of indication lesion 9.5 became <4 at all subsequent time points) and serial bone scans [improvement in 29/39 (72%); stable 10/39 (25%), worse 1/39 (3%)]. The actuarial 4‐year survival from development of metastasis was 39%.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our early results suggest that the use of multimodality therapy including chemotherapy with radiation in unresectable osteosarcoma may be beneficial. Pediatr Blood Cancer 2008;50:976–982. © 2008 Wiley‐Liss, Inc.</jats:p></jats:sec>