Stereotactic radiosurgery, a potential alternative treatment for pulmonary metastases from osteosarcoma

Yu,Wenxi; Tang,Lina; Lin,Feng; Li,Dake; Wang,Jun; Yang,Yao; Shen,Zan

doi:10.3892/ijo.2014.2295

Stereotactic radiosurgery, a potential alternative treatment for pulmonary metastases from osteosarcoma

Authors:
- Wenxi Yu
- Lina Tang
- Feng Lin
- Dake Li
- Jun Wang
- Yao Yang
- Zan Shen
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Affiliations: Department of Oncology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Xuhui, 200233 Shanghai, P.R. China, Department of Gynecology and Obstetrics, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of TCM, 210029 Nanjing, P.R. China, Department of First General Surgery, People's Hospital of Ma An Shan, Ma An Shan, Anhui, P.R. China
Published online on: February 10, 2014 https://doi.org/10.3892/ijo.2014.2295
Pages: 1091-1098
Copyright: © Yu et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 3.0].

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Abstract

Stereotactic radiosurgery (SRS), such as body gamma knife, was reported to achieve excellent rates of local disease control with limited toxicity in many cases of primary or secondary pulmonary tumor, except osteosarcoma. To confirm the value of SRS in pulmonary metastases from osteosarcoma, we reviewed the experience from our institution (Department of Oncology, Affiliated Sixth People's Hospital, Shanghai) and compared the efficiency of SRS with that of surgical resection. From January 2005 to December 2012, we carried out a retrospective investigation of 58 patients (age, 8-59 years; mean, 25.2 years) who were diagnosed with non-metastatic osteosarcoma of the extremity and later developed pulmonary metastasis during the period of adjuvant chemotherapy or follow-up. Among them, 27 patients were treated by SRS using the body gamma-knife system. A total dose of 50 Gy was delivered at 5 Gy/fraction to the 50% isodose line covering the planning target volume, whereas a total dose of 70 Gy was delivered at 7 Gy/fraction to the gross target volume. The other 31 patients were treated by surgical resection. Two-year progression-free survival rate, two-year survival rate, median time of PRPFS (post-relapse progress-free survival) and PROS (post-relapse overall survival) in SRS group were parallel to that in surgical group. All 27 patients tolerated gamma knife radiosurgery well while only 9 patients had grades 1-2 pneumonitis. We believe SRS, compared with surgical resection, is effective and safe in treating pulmonary metastasis from osteosarcoma, especially for those patients who were medically unfit for a resection or who refused surgery.

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1.	Arndt CA and Crist WM: Common musculoskeletal tumors of childhood and adolescence. N Engl J Med. 341:342–352. 1999. View Article : Google Scholar : PubMed/NCBI
2.	Ottaviani G and Jaffe N: The epidemiology of osteosarcoma. Cancer Treat Res. 152:3–13. 2009. View Article : Google Scholar
3.	Friedman MA and Carter SK: The therapy of osteogenic sarcoma: current status and thoughts for the future. J Surg Oncol. 4:482–510. 1972. View Article : Google Scholar : PubMed/NCBI
4.	Ozaki T, Flege S, Kevric M, et al: Osteosarcoma of the pelvis: experience of the Cooperative Osteosarcoma Study Group. J Clin Oncol. 21:334–341. 2003. View Article : Google Scholar : PubMed/NCBI
5.	Tabone MD, Kalifa C, Rodary C, Raquin M, Valteau-Couanet D and Lemerle J: Osteosarcoma recurrences in pediatric patients previously treated with intensive chemotherapy. J Clin Oncol. 12:2614–2620. 1994.PubMed/NCBI
6.	Sternberg DI and Sonett JR: Surgical therapy of lung metastases. Semin Oncol. 34:186–196. 2007. View Article : Google Scholar : PubMed/NCBI
7.	Casiraghi M, De Pas T, Maisonneuve P, et al: 10-year single-center experience on 708 lung metastasectomies: the evidence of the ‘international registry of lung metastases’. J Thorac Oncol. 6:1373–1378. 2011.PubMed/NCBI
8.	Sardenberg RA, Figueiredo LP, Haddad FJ, Gross JL and Younes RN: Pulmonary metastasectomy from soft tissue sarcomas. Clinics. 65:871–876. 2010. View Article : Google Scholar : PubMed/NCBI
9.	Kempf-Bielack B, Bielack SS, Jürgens H, et al: Osteosarcoma relapse after combined modality therapy: an analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS). J Clin Oncol. 23:559–568. 2005. View Article : Google Scholar : PubMed/NCBI
10.	Saltzman DA, Snyder CL, Ferrell KL, Thompson RC and Leonard AS: Aggressive metastasectomy for pulmonic sarcomatous metastases: a follow-up study. Am J Surg. 166:543–547. 1993.PubMed/NCBI
11.	Biccoli A, Rocca M and Salone M: Resection of recurrent pulmonary metastases in patients with osteosarcoma. Cancer. 104:1721–1725. 2005. View Article : Google Scholar : PubMed/NCBI
12.	Bielack SS, Kempf-Bielack B, Branscheid D, et al: Second and subsequent recurrences of osteosarcoma: presentation, treatment, and outcomes of 249 consecutive cooperative osteosarcoma study group patients. J Clin Oncol. 27:557–565. 2009. View Article : Google Scholar
13.	Briccoli A, Rocca M, Salone M, Guzzardella GA, Balladelli A and Bacci G: High grade osteosarcoma of the extremities metastatic to the lung: long-term results in 323 patients treated combining surgery and chemotherapy, 1985–2005. Surg Oncol. 19:193–199. 2010.PubMed/NCBI
14.	Bacci G, Briccoli A, Longhi A, et al: Treatment and outcome of recurrent osteosarcoma: experience at Rizzoli in 235 patients initially treated with neoadjuvant chemotherapy. Acta Oncol. 44:748–755. 2005. View Article : Google Scholar : PubMed/NCBI
15.	Temeck BK, Wexler LH, Steinberg SM, McClure LL, Horowitz M and Pass HI: Metastasectomy for sarcomatous pediatric histologies: results and prognostic factors. Ann Thorac Surg. 59:1385–1389. 1995. View Article : Google Scholar : PubMed/NCBI
16.	Chen F, Miyahara R, Bando T, et al: Repeat resection of pulmonary metastasis is beneficial for patients with osteosarcoma of the extremities. Interact Cardiovasc Thorac Surg. 9:649–653. 2009. View Article : Google Scholar : PubMed/NCBI
17.	Whyte RI: Stereotactic radiosurgery for lung tumors. Semin Thorac Cardiovasc Surg. 22:59–66. 2010. View Article : Google Scholar : PubMed/NCBI
18.	Shin JH, Chao ST and Angelov L: Stereotactic radiosurgery for spinal metastases: update on treatment strategies. J Neurosurg Sci. 55:197–209. 2011.PubMed/NCBI
19.	Katz AJ: CyberKnife radiosurgery for prostate cancer. Technol Cancer Res Treat. 9:463–472. 2010. View Article : Google Scholar : PubMed/NCBI
20.	Murphy MJ, Martin D, Whyte R, Hai J, Ozhasoglu C and Le QT: The effectiveness of breath-holding to stabilize lung and pancreas tumors during radiosurgery. Int J Radiat Oncol Biol Phys. 53:475–482. 2002. View Article : Google Scholar : PubMed/NCBI
21.	Christie NA, Pennathur A, Burton SA and Luketich JD: Stereotactic radiosurgery for early stage non-small cell lung cancer: rationale, patient selection, results, and complications. Semin Thorac Cardiovasc Surg. 20:290–297. 2008. View Article : Google Scholar : PubMed/NCBI
22.	Banki F, Luketich JD and Chen H: Stereotactic radiosurgery for lung cancer. Minerva Chir. 64:589–598. 2009.PubMed/NCBI
23.	Nuyttens JJ and van de Pol M: The CyberKnife radiosurgery system for lung cancer. Expert Rev Med Devices. 9:465–475. 2012. View Article : Google Scholar
24.	Zhang Y, Xiao JP, Zhang HZ, et al: Stereotactic body radiation therapy favors long-term overall survival in patients with lung metastases: five-year experience of a single-institution. Chin Med J. 124:4132–4137. 2011.PubMed/NCBI
25.	Dhakal S, Corbin KS, Milano MT, et al: Stereotactic body radiotherapy for pulmonary metastases from soft-tissue sarcomas: excellent local lesion control and improved patient survival. Int J Radiat Oncol Biol Phys. 82:940–945. 2012. View Article : Google Scholar : PubMed/NCBI
26.	Le QT, Loo BW, Ho A, et al: Results of a phase I dose-escalation study using single-fraction stereotactic radiotherapy for lung tumors. J Thorac Oncol. 1:802–809. 2006. View Article : Google Scholar : PubMed/NCBI
27.	Timmerman R, McGarry R, Yiannoutsos C, et al: Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol. 24:4833–4839. 2006. View Article : Google Scholar : PubMed/NCBI
28.	Xia T, Li H, Sun Q, et al: Promising clinical outcome of stereotactic body radiation therapy for patients with inoperable Stage I/II non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 66:117–125. 2006. View Article : Google Scholar : PubMed/NCBI
29.	Wu D, Zhu H, Tang H, Li C and Xu F: Clinical analysis of stereo-tactic body radiation therapy using extracranial gamma knife for patients with mainly bulky inoperable early stage non-small cell lung carcinoma. Radiat Oncol. 6:842011. View Article : Google Scholar
30.	Bacci G, Picci P, Ruggieri P, et al: Primary chemotherapy and delayed surgery (neoadjuvant chemotherapy) for osteosarcoma of the extremities. The Istituto Rizzoli experience in 127 patients treated peroperatively with intravenous methotrexate (high versus moderate doses) and intraarterial cisplatin. Cancer. 65:2539–2553. 1990.
31.	Bacci G, Picci P, Ferrari S, et al: Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer. 72:3227–3238. 1993. View Article : Google Scholar
32.	Ferrari S, Mercuri M, Picci P, et al: Nonmetastatic osteosarcoma of the extremity: results of a neoadjuvant chemotherapy protocol (IOR/OS-3) with high-dose methotrexate, intraarterial or intravenous cisplatin, doxorubicin, and salvage chemotherapy based on histologic response. Tumori. 85:458–464. 1999.
33.	Bacci G, Briccoli A, Ferrari S, et al: Neoadjuvant chemotherapy for osteosarcoma of the extremity: long-term results of the Rizzoli’s 4th protocol. Eur J Cancer. 37:2030–2039. 2001.
34.	Bacci G, Ferrari S, Longhi A, et al: High-dose ifosfamide in combination with high-dose methotrexate, doxorubicin and cisplatin in the neoadjuvant treatment of extremity osteosarcoma: preliminary results of an Italian Sarcoma Group/Scandinavian Sarcoma Group pilot study. J Chemother. 14:198–206. 2002. View Article : Google Scholar
35.	Bacci G, Ruggieri P, Picci P, et al: Pattern of relapse in patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy. Eur J Cancer. 37:32–38. 2001. View Article : Google Scholar : PubMed/NCBI
36.	Liu HH, Balter P, Tutt T, et al: Assessing respiration-induced tumor motion and internal target volume using four-dimensional computed tomography for radiotherapy of lung cancer. Int J Radiat Oncol Biol Phys. 68:531–540. 2007.PubMed/NCBI