Inoperable or incompletely resected craniofacial osteosarcoma treated by particle radiotherapy
Katharina Seidensaal, Matthias Dostal, Jakob Liermann, Sebastian Adeberg, Fabian Weykamp, Maximillian P. Schmid, Christian Freudlsperger, Jürgen Hoffmann, Ivar Hompland, Klaus Herfarth, Jürgen Debus, Semi Harrabi
Abstract
Background To report survival of craniofacial osteosarcoma patients treated by particle radiotherapy. Methods Between January 2010 and December 2021, 51 patients with primary ( N = 35) or recurrent ( N = 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, N = 18), protons only ( N = 3), carbon ions only ( N = 12), IMRT with a carbon ion boost ( N = 5), and carbon ion re-irradiation ( N = 13). Eighty percent (N = 41) received additionally chemotherapy, most frequently EURAMOS-1 (47%) or EURO-B.O.S.S. (18%). Results The median age was 38, and all patients finished treatment predominantly as outpatients ( N = 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 ( p = 0.006, p = 0.004, p = 0.002, p = 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], p = 0.029 and HR = 0.130, 95% CI = [0.023, 0.724], p = 0.020, respectively). No acute toxicity > grade III was observed. Conclusion CIBRT shows promising results for patients with inoperable or incompletely resected craniofacial osteosarcoma.