Advanced-Technology Radiation Therapy for Bone Sarcomas

Samir Patel, MD; Thomas F. DeLaney, MD


Cancer Control. 2008;15(1):21-37. 

In This Article

Chest Wall Sarcomas

Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) is the most frequent malignant tumor of the chest wall in children and young adults. A review of patients with chest wall PNET treated on two consecutive cooperative group studies (Intergroup 0091 and Pediatric Oncology Group 9354) demonstrated a higher rate of negative surgical margins with delayed resections at week 12 following induction chemotherapy (77%) vs initial resections at presentation (50%; P=.043).[93] Because the indications for RT in patients with Ewing's sarcoma are generally positive surgical margins or unresected tumors, the use of initial chemotherapy decreased the percentage of patients needing RT. Seventeen (70.8%) of 24 patients with initial surgery received RT compared with 34 (47.9%) of 71 patients who started with chemotherapy (P=.061). For patients needing RT, protons can markedly reduce the radiation dose to underlying lung and heart. For patients in whom positive surgical margins are anticipated, preoperative irradiation has conceptual appeal as it can avoid seeding of tumor and unnecessary irradiation of scars and drain sites.[59] For patients presenting with malignant pleural effusions, pleural seeding, or operative contamination of the pleural surfaces at presentation, hemithorax irradiation (generally 15 Gy in 10 fractions for children ≥6 years of age and 12 Gy in 8 fractions for children <6 years of age) has been employed in addition to irradiation of the primary site.[94]


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