AUTHOR=Seidensaal Katharina , Dostal Matthias , Liermann Jakob , Adeberg Sebastian , Weykamp Fabian , Schmid Maximillian P. , Freudlsperger Christian , Hoffmann Jürgen , Hompland Ivar , Herfarth Klaus , Debus Jürgen , Harrabi Semi B. 

TITLE=Inoperable or incompletely resected craniofacial osteosarcoma treated by particle radiotherapy

JOURNAL=Frontiers in Oncology

VOLUME=12

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.927399

DOI=10.3389/fonc.2022.927399

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>To report survival of craniofacial osteosarcoma patients treated by particle radiotherapy.</p></sec><sec><title>Methods</title><p>Between January 2010 and December 2021, 51 patients with primary (<italic>N</italic> = 35) or recurrent (<italic>N</italic> = 16) inoperable or incompletely resected craniofacial osteosarcoma were treated. In most cases, intracranial infiltration (59%) and macroscopic tumor on MRI/CT (75%) were present. Thirteen had a secondary osteosarcoma (25%). Treatment concepts included combined ion beam radiotherapy (CIBRT, <italic>N</italic> = 18), protons only (<italic>N</italic> = 3), carbon ions only (<italic>N</italic> = 12), IMRT with a carbon ion boost (<italic>N</italic> = 5), and carbon ion re-irradiation (<italic>N</italic> = 13). Eighty percent (N = 41) received additionally chemotherapy, most frequently EURAMOS-1 (47%) or EURO-B.O.S.S. (18%).</p></sec><sec><title>Results</title><p>The median age was 38, and all patients finished treatment predominantly as outpatients (<italic>N</italic> = 44). Information on overall survival was available for N = 49 patients. The median follow-up of the survivors was 55 months. For the whole cohort 1-, 2-, 3-, and 5-year overall survival (OS) was 82.8%, 60.4%, 55.2%, and 51.7%, respectively. Those treated by CIBRT (N = 17) demonstrated a superior OS with 92.9% after 1 and 2 years and 83.6% after 3 and 5 years. The median clinical target volume (CTV) was 192.7 and 95.2 cc for the primary and boost plan, respectively. CIBRT, primary diagnosis, age ≤40a, and no macroscopic residual tumor were associated with improved survival in univariate analysis (<italic>p</italic> = 0.006, <italic>p</italic> = 0.004, <italic>p</italic> = 0.002, <italic>p</italic> = 0.026, respectively), while any foregoing resection compared to biopsy was not identified as a prognostic factor. CIBRT and no macroscopic residual tumor were confirmed as independent predictors of OS on multivariate analysis (HR = 0.107, 95% CI = [0.014, 0.797], <italic>p</italic> = 0.029 and HR = 0.130, 95% CI = [0.023, 0.724], <italic>p</italic> = 0.020, respectively). No acute toxicity &gt; grade III was observed.</p></sec><sec><title>Conclusion</title><p>CIBRT shows promising results for patients with inoperable or incompletely resected craniofacial osteosarcoma.</p></sec>