@misc{oai:repo.qst.go.jp:00063674,
 author = {Kamada, Tadashi and Imai, Reiko and Sugahara, Shinji and Tsuji, Hiroshi and Tsujii, Hirohiko and 鎌田 正 and 今井 礼子 and 菅原 信二 and 辻 比呂志 and 辻井 博彦},
 month = {Nov},
 note = {Purpose/Objective(s): Prognosis of unresectable high-grade osteosarcoma of the trunk is invariably dismal. Carbon ion radiotherapy, which is high linear energy transfer charged particle radiotherapy, shows superior depths dose distribution and unique radio-biologic effectiveness when compared with conventional radiotherapy. We analyzed the outcome of patients with unresectable high-grade osteosarcoma of the  trunk treated with carbon ion radiotherapy.
Materials/Methods: We performed a retrospective analysis of 30 patients with unresectable high-grade osteosarcoma of the trunk treated between August 1996 and June 2003 with carbon ion radiotherapy. Tumor sites included the iliac bone in 14 patients, the sacrum in 10, the thoracic spine in 4, the cervical spine in 1, the gluteus muscle in 1, and mediastinum in 1. There were 15 osteoblastic subtype, 10 chondroblastic, 1 fibroblastic, 1 giant cell rich, 1 small cell, 1 telangiectatic, and 1 was not able to determine the subtype. Seven patients were irradiated as their primary treatment of unresectable local disease. Twenty-one patients were irradiated for unresectable local disease after chemotherapy. Four patients were irradiated for unresectable local recurrence after surgery and chemotherapy, and 1 patient was for unresectable mediastinal metastasis after surgery and chemotherapy of osteosarcoma of the humerus. No patients had history of Paget's disease, but 3 patients had the tumor considered to be radiation-associated osteosarcoma, and 1 had the secondary osteosarcoma after resection of giant cell tumor of the ninth thoracic spine. Multi-agent chemotherapy was given in 24 patients before carbon ion radiotherapy. Sixteen patients received multi-agent chemotherapy after the completion of carbon ion radiotherapy. Six patients had no chemotherapy. The applied carbon ion dose was ranging 52.8-73.6 Gy RBE (RBE:3, median 70.4) in 16 fixed fractions over 4 weeks.
Results: A median follow-up of 37 months (range, 5-123 months) showed 8 patients were still alive and continuous disease-free. The overall survival rates at 3 and 5 years were 53% (95% confidence interval [CI], 35-72%) and 29% (95% CI, 13-46%), and the overall local control rates at 3 and 5 years were 62% (95% CI, 43-80%) and 49% (95% CI, 27-71%). Tumor volume of 800 cc or less showed significantly better survival and local control when compared with that of more than 800 cc (vs. p = 0.001 for 5 year survival, vs. p = 0.001 for 5 year local control). Severe skin/soft tissue reaction occurred in 5 patients. No other severe complications were so far experienced.
Conclusions: This analysis showed that carbon ion radiotherapy was effective and safe in the management of the patients with unresectable high-grade osteosarcoma of the trunk, providing substantial local control and offering a survival advantage., The 51st ASTRO Annual Meeting},
 title = {Impact of Carbon Ion Radiotherapy on Outcome in Unresectable High-grade Osteosarcoma of the Trunk},
 year = {2009}
}