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Xue W, Zhang Z, Yu H, Li C, Sun Y, An J, Qi L, Zhang J, Liu Q. Development of nomogram and discussion of radiotherapy effect for osteosarcoma survival. Sci Rep 2023; 13:223. [PMID: 36604532 PMCID: PMC9816159 DOI: 10.1038/s41598-023-27476-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
This study aimed to develop a predictive system for prognostic evaluation of osteosarcoma patients. We obtained osteosarcoma sample data from 1998 to 2016 using SEER*Stat software version 8.3.8, and established a multivariable Cox regression model using R-4.0.3 software. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The diagnosis of the model was completed through influential cases, proportionality, and multicollinearity. The predictive ability of the model was tested using area under the curve (AUC), calibration curves, and Brier scores. Finally, the bootstrap method was used to internally verify the model. In total, data from 3566 patients with osteosarcoma were included in this study. The multivariate Cox regression model was used to determine the independent prognostic variables. A nomogram and Kaplan-Meier survival curve were established. The AUC and Brier scores indicated that the model had a good predictive calibration. In addition, we found that the radiotherapy appears to be a risk factor of patients with osteosarcoma and made a discussion. We developed a prognostic evaluation system for patients with osteosarcoma for 1-, 3-, and 5-year overall survival with good predictive ability using sample data extracted from the SEER database. This has important clinical significance for the early identification and treatment of high-risk groups of osteosarcoma patients.
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Affiliation(s)
- Wu Xue
- grid.452829.00000000417660726Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, People’s Republic of China
| | - Ziyan Zhang
- grid.452829.00000000417660726Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, People’s Republic of China
| | - Haichi Yu
- grid.452829.00000000417660726Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, People’s Republic of China
| | - Chen Li
- grid.452829.00000000417660726Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yang Sun
- grid.452829.00000000417660726Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, People’s Republic of China
| | - Junyan An
- grid.452829.00000000417660726Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, People’s Republic of China
| | - Le Qi
- grid.452829.00000000417660726Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, People’s Republic of China
| | - Jun Zhang
- Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, People's Republic of China.
| | - Qinyi Liu
- Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, People's Republic of China.
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Hız M, Karaismailoglu B, Ulutas S, Camurdan VB, Gorgun B, Oner Dincbas F. The effect of preoperative radiotherapy on local control and prognosis in high-grade non-metastatic intramedullary osteosarcoma of the extremities. Arch Orthop Trauma Surg 2021; 141:1083-1089. [PMID: 32506177 DOI: 10.1007/s00402-020-03494-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/31/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION This study aimed to analyse the effect of preoperative radiotherapy on survival, recurrence and necrosis rates in osteosarcoma patients treated with neoadjuvant chemotherapy and limb-salvage surgery. MATERIALS AND METHODS Osteosarcoma patients who referred to our clinic from 1998 to 2015 were investigated retrospectively. 141 patients with non-metastatic osteosarcoma of the limb who received neoadjuvant chemotherapy and underwent limb-sparing surgery with or without preoperative radiotherapy were included in the study. 73 patients had neoadjuvant chemotherapy only (CT group), while 68 patients had additional preoperative radiotherapy (CT + RT group). 5-year survival, disease-free survival, limb survival, local recurrence, metastasis, complication and necrosis rates were compared between the two groups. RESULTS Overall 5-year survival, 5-year disease-free survival, 5-year limb survival rates were 68.5, 64.3, 65.7 for CT group and 72.1, 67.6, 64.7 for CT + RT group, respectively. Preoperative radiotherapy gave similar survival and disease-free survival rates. Limb survival, recurrence and metastasis rates were similar between the groups. The necrosis rate of the lesions was significantly higher in the CT + RT group compared to the CT group. CONCLUSION Preoperative radiotherapy can provide a higher necrosis rate and may allow the resection of unresectable lesions in the treatment of osteosarcoma. CT + RT provided similar 5-year survival despite the larger tumour size compared to CT group. Due to the higher wound complication rate (8.2% in CT, 23.5% in CT + RT group, p = 0.01), CT + RT should be restricted to the lesions with large size or close proximity to neurovascular structures. LEVEL OF EVIDENCE Level III; Therapeutic, Retrospective comparative study.
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Affiliation(s)
- Murat Hız
- Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Istanbul, 34093, Turkey
| | - Bedri Karaismailoglu
- Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Istanbul, 34093, Turkey.
| | - Suat Ulutas
- Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Istanbul, 34093, Turkey
| | - Vedat Burkay Camurdan
- Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Istanbul, 34093, Turkey
| | | | - Fazilet Oner Dincbas
- Cerrahpasa Medical Faculty, Department of Radiation Oncology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Spałek MJ, Poleszczuk J, Czarnecka AM, Dudzisz-Śledź M, Napieralska A, Matysiakiewicz J, Chojnacka M, Raciborska A, Sztuder A, Maciejczyk A, Szulc A, Skóra T, Cybulska-Stopa B, Winiecki T, Kaźmierska J, Tomasik B, Fijuth J, Rutkowski P. Radiotherapy in the Management of Pediatric and Adult Osteosarcomas: A Multi-Institutional Cohort Analysis. Cells 2021; 10:cells10020366. [PMID: 33578676 PMCID: PMC7916348 DOI: 10.3390/cells10020366] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/31/2021] [Accepted: 02/07/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Due to the rarity of osteosarcoma and limited indications for radiotherapy (RT), data on RT for this tumor are scarce. This study aimed to investigate the utilization of RT for osteosarcomas in the recent 20 years and to identify factors related to patients’ response to radiation. Methods: We performed a retrospective analysis of patients irradiated for osteosarcoma treatment. We planned to assess differences in the utilization of RT between the periods of 2000–2010 and 2011–2020, identify the risk factors associated with local progression (LP), determine whether RT-related parameters are associated with LP, and calculate patients’ survival. Results: A total of 126 patients with osteosarcoma who received 181 RT treatments were identified. We found a difference in RT techniques between RT performed in the years 2000–2010 and that performed in the years 2011–2020. LP was observed after 37 (20.4%) RT treatments. Intent of RT, distant metastases, and concomitant systemic treatment affected the risk of LP. Five-year overall survival was 33% (95% confidence interval (26%–43%)). Conclusions: RT for osteosarcoma treatment has evolved from simple two-dimensional palliative irradiation into more conformal RT applied for new indications including oligometastatic and oligoprogressive disease. RT may be a valuable treatment modality for selected patients with osteosarcoma.
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Affiliation(s)
- Mateusz Jacek Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.C.); (M.D.-Ś.); (P.R.)
- Correspondence: ; Tel.: +48-22-546-24-55
| | - Jan Poleszczuk
- Department for Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-034 Warsaw, Poland;
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 02-109 Warsaw, Poland
| | - Anna Małgorzata Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.C.); (M.D.-Ś.); (P.R.)
- Mossakowski Medical Research Centre, Department of Experimental Pharmacology, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Monika Dudzisz-Śledź
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.C.); (M.D.-Ś.); (P.R.)
| | - Aleksandra Napieralska
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Jacek Matysiakiewicz
- Trauma and Orthopedic Surgery Department, IXth Ward of the District Hospital of Orthopedics and Trauma Surgery in Piekary Slaskie, 41-940 Piekary Slaskie, Poland;
| | - Marzanna Chojnacka
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 02-034 Warsaw, Poland;
| | - Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Aleksandra Sztuder
- Department of Radiotherapy, Lower Silesian Oncology Centre, 53-413 Wroclaw, Poland; (A.S.); (A.M.); (A.S.)
| | - Adam Maciejczyk
- Department of Radiotherapy, Lower Silesian Oncology Centre, 53-413 Wroclaw, Poland; (A.S.); (A.M.); (A.S.)
- Department of Oncology, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Agata Szulc
- Department of Radiotherapy, Lower Silesian Oncology Centre, 53-413 Wroclaw, Poland; (A.S.); (A.M.); (A.S.)
| | - Tomasz Skóra
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland;
| | - Bożena Cybulska-Stopa
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 31-115 Kraków, Poland;
| | - Tomasz Winiecki
- Radiotherapy Department II, Greater Poland Cancer Centre, 61-866 Poznan, Poland; (T.W.); (J.K.)
| | - Joanna Kaźmierska
- Radiotherapy Department II, Greater Poland Cancer Centre, 61-866 Poznan, Poland; (T.W.); (J.K.)
- Electroradiology Department, University of Medical Sciences, 61-701 Poznan, Poland
| | - Bartłomiej Tomasik
- Department of Radiotherapy, Medical University of Lodz, 92-215 Lodz, Poland; (B.T.); (J.F.)
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 95-513 Lodz, Poland
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Jacek Fijuth
- Department of Radiotherapy, Medical University of Lodz, 92-215 Lodz, Poland; (B.T.); (J.F.)
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.C.); (M.D.-Ś.); (P.R.)
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Sun HB, Wang HY, Wu B, Wang ZF, Wang LZ, Li FQ, Wu JD, Zhang LN. The inhibitory effects of cisplatin-radiation combination treatment on malignant osteosarcoma MG-63 cells and BRCA1-p53 pathways are more efficient than single treatments. Oncol Lett 2019; 18:6385-6396. [PMID: 31807162 PMCID: PMC6876329 DOI: 10.3892/ol.2019.11019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/22/2019] [Indexed: 01/07/2023] Open
Abstract
The poor prognosis of patients with osteosarcoma remains a persistent problem, in particular for patients with unresectable tumors or metastasis. Therefore, combination of radiotherapy and chemotherapy has been considered for patients with metastasis or recurrence, patients unsuitable for surgery and patients refusing surgery. The present study aimed to investigate the effect of the combined treatment with cisplatin and radiation therapy on the biological characteristics of the osteosarcoma cell line MG-63 and the breast cancer 1 (BRCA1)-associated signaling pathways. Cell proliferation was determined using Cell Counting kit-8 assay, and cell apoptosis and cell cycle were assessed by flow cytometry. Cell migration was examined by Transwell assay. The mRNA and protein expression levels of candidate genes, including BRCA1 and p53, were determined by reverse transcription-quantitative PCR and western blotting, respectively. The results demonstrated that combined treatment with radiation and cisplatin significantly inhibited MG-63 cell proliferation compared with radiation or cisplatin treatment alone. Furthermore, radiation, cisplatin or the combined treatment with radiation and cisplatin increased the apoptosis rate of MG-63 cells, which resulted in G2 phase arrest, and significantly decreased the migratory capacity of MG-63 cells. In addition, the apoptosis rate of MG-63 cells following combined radiation and cisplatin treatment was higher compared with the cisplatin group, but lower compared with the radiation group. Furthermore, combined treatment with radiation and cisplatin decreased the mRNA and protein expression levels of BRCA1 and p53. Additionally, combined treatment with radiation and cisplatin had a more potent inhibitory effect on p53 expression than on BRCA1 expression. In addition, combination of radiation and cisplatin had a higher inhibitory effect on Bax protein level and a higher inductive effect on Bcl-2 protein level compared with treatments with radiation and cisplatin alone. The results demonstrated that combined treatment of radiation and cisplatin exhibited superior therapeutic effects on osteosarcoma MG-63 cells compared with radiation or cisplatin treatment alone, which may be mediated by the BRCA1-p53 signaling pathway.
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Affiliation(s)
- Hong-Bin Sun
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - He-Yuan Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Bing Wu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhong-Feng Wang
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Li-Zhe Wang
- Department of Pediatric Oncology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Fu-Qiang Li
- Eye Center of The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Jun-Duo Wu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Le-Ning Zhang
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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CRIF1 as a potential target to improve the radiosensitivity of osteosarcoma. Proc Natl Acad Sci U S A 2019; 116:20511-20516. [PMID: 31548420 DOI: 10.1073/pnas.1906578116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Resistance to ionizing radiation (IR), which is a conventional treatment for osteosarcoma that cannot be resected, undermines the efficacy of this therapy. However, the mechanism by which IR induces radioresistance in osteosarcoma is not defined. Here, we report that CR6-interacting factor-1 (CRIF1) is highly expressed in osteosarcoma and undergoes nuclear-cytoplasmic shuttling of cyclin-dependent kinase 2 (CDK2) after IR. Osteosarcoma cells lacking CRIF1 show increased sensitivity to IR, which is associated with delayed DNA damage repair, inactivated G1/S checkpoint, and mitochondrial dysfunction. CRIF1 interacts with the DNA damage checkpoint regulator CDK2, and CRIF1 and CDK2 colocalize in the nucleus after IR. Nuclear localization of CDK2 is associated with phosphorylation changes that promote DNA repair and activation of the G1/S checkpoint. CRIF1 knockdown synergized with IR in an in vivo osteosarcoma model, leading to tumor regression. Based on these findings, we identify CRIF1 as a potential therapeutic target in osteosarcoma that can increase the efficacy of radiotherapy. More broadly, our findings may provide insights into the mechanism for other types of radioresistant cancers and be exploited for therapeutic ends.
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Zhang ZC, Tang C, Dong Y, Zhang J, Yuan T, Li XL. Targeting LncRNA-MALAT1 suppresses the progression of osteosarcoma by altering the expression and localization of β-catenin. J Cancer 2018; 9:71-80. [PMID: 29290771 PMCID: PMC5743713 DOI: 10.7150/jca.22113] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/24/2017] [Indexed: 12/29/2022] Open
Abstract
Osteosarcoma (OS), which affects adolescents especially during a growth spurt, has the highest incidence of any primary malignant bone tumour, and a high rate of early metastasis leading to a very poor prognosis. In recent years, non-coding RNAs, especially long non-coding RNAs (lncRNAs) have attracted more and more attention as novel epigenetic regulators in a variety of tumours, including OS. Most recently, metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) was found to play an important role in OS progression by modulating the enhancers of zeste homolog 2 (EZH2). Furthermore, MALAT1 could inhibit the expression of E-cadherin and promote the expression of β-catenin, and this phenomenon might be the outcome of MALAT1-induced EZH2 activation. In this study, we investigated the vital function of MALAT1 in the progression of OS and its potential leading mechanism, altering the expression and localization of β-catenin via epigenetic transcriptional regulation by interacting with EZH2. With the help of MALAT1 silencing using small interfering RNAs (siRNAs), the loss of E-cadherin of MNNG/HOS cells was rescued, and the abnormal expression and localization of β-catenin were corrected at the same time. Overall, our research showed promising potential for new treatment strategies based on epigenetic regulation targeting MALAT1, which will not only coordinate with the patient's immune system, but also eliminate OS in conjunction with chemotherapy.
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Affiliation(s)
- Zhi-Chang Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Chun Tang
- Department of Nursing, Guangming Traditional Chinese Medicine Hospital, Pudong New Area, Shanghai 201300, China
| | - Yang Dong
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Jing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Ting Yuan
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Xiao-Lin Li
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
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Sole CV, Calvo FA, Alvarez E, Cambeiro M, Cuervo M, San Julian M, Sole S, Martinez-Monge R, Sierrasesumaga L. Adjuvant radiation therapy in resected high-grade localized skeletal osteosarcomas treated with neoadjuvant chemotherapy: Long-term outcomes. Radiother Oncol 2016; 119:30-4. [PMID: 26970678 DOI: 10.1016/j.radonc.2016.02.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/26/2016] [Accepted: 02/27/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess long-term outcomes and toxicity of adjuvant radiotherapy in the post-surgical management of patients with resected high-grade skeletal osteosarcomas. METHODS AND MATERIALS Seventy-two patients with primary resected osteosarcomas underwent adjuvant radiotherapy after neoadjuvant chemotherapy from December 1984 to December 2008. Local control (LC), overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier methods. For survival outcomes potential associations were assessed in univariate and multivariate analyses using the Cox proportional hazards model. RESULTS After a median follow-up of 174months (range, 33-363months), 10-year LC, DFS, and OS rates were 82%, 58%, and 73%, respectively. In the multivariate analysis only R1 margin status (p=0.02) remained significantly associated with LC. Patients with tumor necrosis <90% (p=0.04) and R1 resection margin (p=0.05) remained at a significantly higher risk of mortality on multivariate analysis. Six patients (8%) developed grade ⩾3 treatment-related chronic toxicity events. No grade 5 toxicities were reported. CONCLUSIONS A multimodal radiotherapy-containing approach is a well-tolerated component of treatment for patients with osteosarcomas undergoing programed resection, allowing low toxicity rates while maintaining high local control rates.
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Affiliation(s)
- Claudio V Sole
- Department of Radiation Oncology, Clinica Instituto de Radiomedicina (IRAM), Santiago, Chile.
| | - Felipe A Calvo
- Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain
| | - Eduardo Alvarez
- Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mauricio Cambeiro
- Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Miguel Cuervo
- Service of Orthopedic Surgery and Traumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mikel San Julian
- Service of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sebastian Sole
- Department of Radiation Oncology, Clinica Instituto de Radiomedicina (IRAM), Santiago, Chile; Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
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Bone-seeking radiopharmaceuticals as targeted agents of osteosarcoma: samarium-153-EDTMP and radium-223. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 804:291-304. [PMID: 24924181 DOI: 10.1007/978-3-319-04843-7_16] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Osteosarcoma is a cancer characterized by formation of bone by malignant cells. Routine bone scan imaging with Tc-99m-MDP is done at diagnosis to evaluate primary tumor uptake and check for bone metastases. At time of relapse the Tc-99m-MDP bone scan also provides a specific means to assess formation of bone by malignant osteosarcoma cells and the potential for bone-seeking radiopharmaceuticals to deliver radioactivity directly into osteoblastic osteosarcoma lesions. This chapter will review and compare a bone-seeking radiopharmaceutical that emits beta-particles, samarium-153-EDTMP, with an alpha-particle emitter, radium-223. The charged alpha particles from radium-223 have far more mass and energy than beta particles (electrons) from Sm-153-EDTMP. Because radium-223 has less marrow toxicity and more radiobiological effectiveness, especially if inside the bone forming cancer cell than samarium-153-EDTMP, radium-223 may have greater potential to become widely used against osteosarcoma as a targeted therapy. Radium-223 also has more potential to be used with chemotherapy against osteosarcoma and bone metastases. Because osteosarcoma makes bone and radium-223 acts like calcium, this radiopharmaceutical could possibly become a new targeted means to achieve safe and effective reduction of tumor burden as well as facilitate better surgery and/or radiotherapy for difficult to resect large, or metastatic tumors.
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Li X, Huang T, Jiang G, Gong W, Qian H, Zou C. Synergistic apoptotic effect of crocin and cisplatin on osteosarcoma cells via caspase induced apoptosis. Toxicol Lett 2013; 221:197-204. [PMID: 23830991 DOI: 10.1016/j.toxlet.2013.06.233] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/21/2013] [Accepted: 06/22/2013] [Indexed: 01/18/2023]
Abstract
Crocin is well-known traditional Chinese medicine which is extracted from saffron. However, its role in osteosarcoma has not been well understood. Therefore, we used crocin and cisplatin individually or jointly on MG63 and OS732 cells so as to explore whether crocin could induce cellular apoptosis and suppress the ability of invasion of osteosarcoma cells. Cell survival rates, changes of cellular shape, cell apoptosis and cell invasion were analyzed, respectively, by 3-(4,5)-dimethylthiahiazo (-z-y1)-2,5-di- phenytetrazoliumromide (MTT) assay, inverted phase contrast microscope and fluorescence microscope, flow cytometry, and Transwell invasion chamber methods. The expressions of caspase-3 and caspase-8 were detected by Western blot. The survival rate of combined application was significantly lower than that of the individual application. Apoptosis-inducing effect of combined application was much stronger than that of individual application. The invasion ability of MG63 and OS732 cells was restrained significantly in the combined group compared with the individual group and control group. Combined group has the effect of up-regulating the expressions of cleaved-caspase-3 and caspase-8. The results suggested that combination of crocin and cisplatin has a strong killing effect on osteosarcoma cells and suppresses the ability of invasion of MG63 and OS732 cells which might be related to up-regulate the expression of caspase-3 and caspase-8.
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Affiliation(s)
- Xiucheng Li
- Department of Orthopedics, The First Affiliated Hospital of China Medical University, Shenyang, 110001 Liaoning, PR China
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Kawano M, Nishida H, Nakamoto Y, Tsumura H, Tsuchiya H. Cryoimmunologic antitumor effects enhanced by dendritic cells in osteosarcoma. Clin Orthop Relat Res 2010; 468:1373-83. [PMID: 20232181 PMCID: PMC2853649 DOI: 10.1007/s11999-010-1302-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 03/01/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND We previously reported a limb-salvage technique by treating tumor-bearing bone with liquid nitrogen. We also reported systemic antitumor immunity was enhanced by cryotreatment in a murine osteosarcoma (LM8) model. We therefore combined the cryotreatment of tumor with dendritic cells to promote tumor-specific immune responses. QUESTIONS/PURPOSES We determined whether our technique could enhance systemic immune response and inhibit metastatic tumor growth in a murine osteosarcoma model. MATERIALS AND METHODS To evaluate activation of the immune response, we prepared six groups of C3H mice (80 mice total): (1) excision only, (2) dendritic cells without reimplantation of the cryotreated primary tumor, (3) reimplantation of the cryotreated primary tumor alone, (4) dendritic cells combined with reimplantation of the cryotreated primary tumor, (5) dendritic cells exposed to cryotreated tumor lysates without reimplantation of the cryotreated primary tumor, and (6) dendritic cells exposed to cryotreated tumor lysates with reimplantation of the cryotreated primary tumor. We then compared and verified the activation state of each group's antitumor immunity. RESULTS Mice that received dendritic cells exposed to cryotreated tumor lysates with reimplantation of the cryotreated primary tumor group had high serum interferon gamma, reduced pulmonary metastases, and increased numbers of CD8(+) T lymphocytes in the metastatic areas. CONCLUSIONS Combining tumor cryotreatment with dendritic cells enhanced systemic immune responses and inhibited metastatic tumor growth. CLINICAL RELEVANCE We suggest immunotherapy could be developed further to improve the treatment of osteosarcoma.
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Affiliation(s)
- Masanori Kawano
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
- Department of Orthopaedics Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hideji Nishida
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Yasunari Nakamoto
- Department of Gastroenterology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedics Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
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Ayan I, Kebudi R, Ozger H. Childhood osteosarcoma: multimodal therapy in a single-institution Turkish series. Cancer Treat Res 2009; 152:319-338. [PMID: 20213399 DOI: 10.1007/978-1-4419-0284-9_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Between January 1990 and December 2006, 123 patients<or=16 years with the histopathologic diagnosis of osteosarcoma were treated with a chemotherapy regimen comprising epirubicin, cisplatin, and ifosfamide. The mean follow-up time was 36 months (range 2-219 months). Among the 94 patients analyzed, 68 patients (72.3%) were alive at the time of the analysis. A total of 26 patients (13 each with nonmetastatic and metastatic disease) died; 20 of these (9 with nonmetastatic disease and 11 with metastatic disease) died of disease; 5, of chemotherapy toxicity, and 1, of nonmetastatic disease from acute nonlymphoid leukemia 13 months following the cessation of osteosarcoma therapy. The estimated 5- and 10-year Overall Survival (OS) rates for all patients were 64.7% (95% confidence interval [95% CI] 74.8-52.94%) and 62.2% (95% CI 74.6-49.9%), respectively. The Event Free Survival (EFS) rate for all patients was 51.8% (95% CI 40.2-63.4%) at both 5 and 10 years. The estimated 5- and 10-year Overall Survival (OS) rates for patients with nonmetastatic disease were 78.3% (95% CI 66.9-89.7%) and 75.1 (95% CI 62.6-87.6%), respectively; this 5-year rate was significantly superior to that of patients with metastatic disease, 13.5% (95% CI 0-30.8%) (p<0.001). The estimated EFS rate for patients with nonmetastatic disease was 62.4% (95% CI 49.9-79.9%) at both 5 and 10 years and was significantly better than the 5-year EFS of 6.9% (95% CI 0-19.9%) in patients with metastatic disease (p<0.001). Progression during preoperative chemotherapy was encountered in 18 patients (19.1%), 11 of whom had metastatic disease at diagnosis. Four patients (three with nonmetastatic disease and one with metastatic disease) underwent salvage treatment consisting of early surgical intervention and preoperative radiation. The estimated 5- and 10-year OS rates were 13% (95% CI 0-29.7%) for patients who had progression during treatment; this rate was significantly inferior to both the 5- and 10-year OS rates for patients without progressive disease, which were 78.2% (95% CI 66.1-90.4%) and 75% (95% CI 61.9-83.1%), respectively (p<0.001). A total of 33 patients experienced relapse and/or progression at a median time of 9 months (range 0-40 months). Histologic response (<90% necrosis vs. >or=90%) was significantly correlated with the 5-year EFS (31% vs. 67.6%, respectively, p=0.023) but not with OS (57.7% vs. 76.5%, respectively, p=0.13). The presence of metastases at diagnosis was found to be the most significant single characteristic influencing the outcome. The rate of histologically good response to preoperative chemotherapy was 64.5%, which is comparable with the 28-85% response rates given in the literature. Our results demonstrate that the combination of epirubicin, cisplatin, and ifosfamide is an active and reasonably well-tolerated regimen for childhood osteosarcoma.
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Affiliation(s)
- Inci Ayan
- Department of Pediatric Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey.
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Schwarz R, Bruland O, Cassoni A, Schomberg P, Bielack S. The role of radiotherapy in oseosarcoma. Cancer Treat Res 2009; 152:147-164. [PMID: 20213389 DOI: 10.1007/978-1-4419-0284-9_7] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A survey of the literature shows that the experience with radiotherapy (RT) in the local treatment of osteosarcoma (OS) is limited. This is due to various reasons: OS is a rare tumor and surgery is the treatment of choice with high local control rate, and uncertainty exists in regard to the efficacy and tolerance of radiotherapy. Publications on this topic were analyzed and will be reviewed. Furthermore, experience from the Cooperative Osteosarkomstudiengruppe (COSS)-Registry, including 100 patients (pts) treated using radiotherapy for OS, was analyzed. The COSS-registry includes a total of 175 pts (5% of all pts) with histologically proven OS irradiated over the period of 1980-2007. 100 pts were eligible for analysis. The median age was 18 (3-66) years. Indication for RT was a primary tumor in 66, a local recurrence in 11, and metastases in 23 pts. 94 pts got external photontherapy; 2 pts, proton therapy; 2 pts, neutron therapy; and 2 pts, intraoperative RT. In addition, a group of 17 pts received bone-targeted radionuclide therapy by samarium-153-EDTMP-therapy alone or in combination with external RT. The median dose for external RT was 55.8 Gy (30-120). All the pts received chemotherapy in accordance with different COSS-protocols. The median follow-up was 1.5 (0.2-23) years. Survival and local control rates at 5 years were calculated, and univariate and multivariate analyses performed. 41 pts are alive, 59 pts died. The overall survival rate after biopsy was 41% at 5 years, while the overall survival rates after RT for the whole group, for treatment of primary tumors, local recurrence, and metastases were 36%, 55%, 15%, and 0% respectively.In 41 cases, local control was achieved, whereas local progression or local recurrence occurred in 59 cases, with a median time to local recurrence of 0.5 (0.1-4) years after RT. 15 pts were nonresponders to radiotherapy. Local control for the whole group was 30%. Local control rates for combined surgery and RT were significantly better than those for RT alone (48% vs. 22%, p=0.002). Local control for treatment of primary tumors, local recurrence, and metastases were 40%, 17%, and 0% respectively. Local control for pts given an addition of samarium-153-EDTMP was poor, though not statistically significant. A dose of over 60 Gy had no significant effect on local control. Prognostic factors for survival were indication for RT, RT plus surgery vs. RT alone and tumor location. Prognostic factors for local control were indication for RT, and RT plus surgery vs. RT alone. For the majority of pts, surgery remains the local treatment of choice. Radiotherapy is an important option as local treatment of unresectable tumors, following intralesional resection, or as palliation of symptomatic metastases. Survival prognosis of such pts, however, is poor. Despite the fact that many of these pts will eventually die, they may benefit in terms of prolonged survival and prolonged local control. The combination of surgery, radiotherapy, and chemotherapy can be curative. The consistent use of full-dose chemotherapy is of importance for the response to radiotherapy. Prognostic factors for survival are indication for RT, RT plus surgery vs. RT alone and tumor location. Prognostic factors for local control are indication for RT, and RT plus surgery vs. RT alone.
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Affiliation(s)
- Rudolf Schwarz
- Department of Radiation Oncology, Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, D-20246, Germany.
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Baumann M, Krause M. Tumor Biology’s Impact on Clinical Cure Rates. THE IMPACT OF TUMOR BIOLOGY ON CANCER TREATMENT AND MULTIDISCIPLINARY STRATEGIES 2009. [DOI: 10.1007/978-3-540-74386-6_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
Studies have demonstrated that chemotherapy alone is usually unsuccessful as exclusive therapy for osteosarcoma (Cancer 95:2202-2201, 2002). Information will be presented for situations where non-surgical alternatives could be considered as useful, if not necessary, adjuncts to chemotherapy. In the thorax these include treatment of pleural effusions, chest wall lesions, central lung or mediastinal osteosarcoma, as well as recurrences in patients with limited pulmonary reserve. Other situations include too many metastases to easily resect, axial osteosarcomas, bone metastases, liver and brain metastases. Non-surgical local control measures include radiation with chemotherapy for radiosensitization, bone-seeking radioisotopes (e.g., 153Sm-EDTMP, 223Ra), bisphosphonates, heat (radiofrequency ablation), freezing and thawing (cryoablation), and intracavitary or regional (aerosol) therapy. Because of the predictable and common pattern of pulmonary metastases in osteosarcoma, aerosol therapy also offers an attractive regional treatment strategy. Principles and use of aerosol cytokines (e.g., GM-CSF, IL-2), and aerosol chemotherapy with gemcitabin will be discussed. Individual cases illustrating strategy and techniques will be presented.
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Affiliation(s)
- Pete Anderson
- Children's Cancer Hospital, University of Texas MD Anderson Cancer Center, Unit 87, Pediatrics, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA.
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Anderson P, Kornguth D, Ahrar K, Hughes D, Phan P, Huh W, Cornelius K, Mahajan A. Recurrent, refractory, metastatic and/or unresectable pediatric sarcomas: treatment options for young people ‘off the roadmap’. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17455111.2.5.605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although sarcoma surgery is very important for cancer control, it is not always possible or practical to offer in some situations, including sarcoma recurrences, metastatic disease and/or unacceptable loss of function. We review some pragmatic approaches and examples of how to balance indications, risks and alternatives to control cancer in young people with sarcomas that are no longer using ‘front-line’ therapy. Radiotherapy combined with chemotherapy and outpatient ‘continuation’ chemotherapy regimens using drugs that cause less alopecia can improve function and quality of life. Some effective strategies to help cope when cure is not possible may include tumor ablation techniques performed in interventional radiology and percutaneous nerve blocks. Family centered care and effective problem solving of difficult issues can be greatly facilitated by consultation with a multidisciplinary team experienced in the management of very difficult cases. Treatment of young people with recurrent, relapsed and/or metastatic sarcoma still remains an art very much in the realm of compassion not protocol and persistent advocacy is required for the young person for whom cure may not be possible. A reduction of suffering and assistance in writing more chapters of a rich life narrative is the goal.
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Affiliation(s)
- Pete Anderson
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
| | - David Kornguth
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
- Department of Radiation Oncology
| | - Kamran Ahrar
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
- Department of Diagnostic Radiology
| | - Dennis Hughes
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
| | - Phil Phan
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
- Department of Anesthesia & Cancer Pain Service
| | - Winston Huh
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
| | - Kathleen Cornelius
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
| | - Anita Mahajan
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
- Department of Radiation Oncology
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Mahajan A, Woo SY, Kornguth DG, Hughes D, Huh W, Chang EL, Herzog CE, Pelloski CE, Anderson P. Multimodality treatment of osteosarcoma: radiation in a high-risk cohort. Pediatr Blood Cancer 2008; 50:976-82. [PMID: 18213710 DOI: 10.1002/pbc.21451] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Chemotherapy during radiation and/or bone-seeking radioisotope therapy (153-samarium; 1 mCi/kg) during radiation may improve osteosarcoma cancer control. PATIENTS AND METHODS 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). RESULTS 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%. CONCLUSIONS Our early results suggest that the use of multimodality therapy including chemotherapy with radiation in unresectable osteosarcoma may be beneficial.
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Affiliation(s)
- Anita Mahajan
- Department of Radiation Oncology, UT M.D. Anderson Cancer Center, Houston, Texas, USA.
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Anderson P, Aguilera D, Pearson M, Woo S. Outpatient Chemotherapy plus Radiotherapy in Sarcomas: Improving Cancer Control with Radiosensitizing Agents. Cancer Control 2008; 15:38-46. [DOI: 10.1177/107327480801500105] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Cancer control by radiotherapy (RT) can be improved with concurrent chemotherapy. Outpatient strategies for sarcomas that combine chemotherapy and RT are possible since supportive care and RT techniques have improved. Methods The current status of non-anthracycline chemotherapy in combination with radiation for high-risk sarcoma is reviewed. Results Ifosfamide with mesna and newer activated ifosfamide agents (ZIO-201 and glufosfamide) have high potential to improve sarcoma cancer control. In Ewing's sarcoma and osteosarcoma, high-dose ifosfamide with mesna (2.8 g/m2/day of each x 5 days; mesna day 6) can be safely given to outpatients using continuous infusion. Reducing ifosfamide nephrotoxicity and central nervous system side effects are discussed. Other outpatient radiosensitization regimens include gemcitabine (600–1000 mg/m2/dose IV over 1 hour weekly x 2–3 doses), temozolomide (75 mg/m2/daily x 3–6 weeks), or temozolomide (100 mg/m2/dose daily x 5) + irinotecan (10 mg/m2/dose daily x 5 x 2 weeks). In osteosarcoma with osteoblastic metastases on bone scan, samarium (1 mCi/kg; day 3 of RT) and gemcitabine (600 mg/m2 IV over 1 hour day 9 of RT) is a radiosensitization strategy. Future drugs for radiosensitization include beta-D-glucose targeted activated ifosfamide (glufosfamide) and sapacitabine, an oral nucleoside with in vitro activity against solid tumors including sarcomas. Conclusions The potential to treat major causes of sarcoma treatment failure (local recurrence and distant metastases) with concurrent chemotherapy during radiation should be considered in high-grade sarcomas.
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Affiliation(s)
- Pete Anderson
- Departments of Pediatrics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Dolly Aguilera
- Departments of Pediatrics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Margaret Pearson
- Departments of Pediatrics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Shaio Woo
- Radiation Oncology at The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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