Advanced-Technology Radiation Therapy for Bone Sarcomas

Samir Patel, MD; Thomas F. DeLaney, MD

Disclosures

Cancer Control. 2008;15(1):21-37. 

In This Article

Ewing's Sarcoma

Management of truncal, craniofacial, spinal, and pelvic Ewing's sarcoma is complex due to (1) the critical importance of the normal structures in the vicinity of the tumor and (2) the frequent need for surgical resection with positive or close margins. For these sites, surgical resection and radiation can be limited by the proximity of the tumor to critical organs such as liver, kidney, bowel, and great vessels. Local failure rates are often more than 50%.[90] Highly localized dose distributions offer the possibility of increasing local control as well as decreasing late effects. Smith et al[91] performed a treatment planning comparison between intensity-modulated photons with intensity-modulated protons for a patient with a pelvic Ewing's sarcoma and noted sparing of the intestine, rectum, bladder, and femoral head in the proton plan compared to the photon plan. These results demonstrate a significant potential for reduction of treatment morbidity for the proton plan compared to the photon plan. In addition to less acute morbidity to bowel and marrow during concurrent chemoradiation, one would anticipate a reduction in late radiation-induced tumors, which are a problem with conventional photon RT for these patients.[92] Proton beam RT has been approved for use in Children's Cooperative Oncology Group protocols.

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