Local surgery feasibility and safety after carbon ion radiotherapy for primary bone sarcomas

Hideaki Sabe; Hidetatsu Outani; Yoshinori Imura; Haruna Takami; Takaaki Nakai; Satoshi Takenaka; Shigeki Kakunaga; Hironari Tamiya; Toru Wakamatsu; Sho Nakai; Yusuke Demizu; Reiko Imai; Seiji Okada

doi:10.1016/j.jos.2023.03.016

Local surgery feasibility and safety after carbon ion radiotherapy for primary bone sarcomas

J Orthop Sci. 2023 Apr 10:S0949-2658(23)00086-6. doi: 10.1016/j.jos.2023.03.016. Online ahead of print.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
² Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan. Electronic address: h.otani@ort.med.osaka-u.ac.jp.
³ Department of Orthopaedic Surgery, Itami City Hospital, Itami, Japan.
⁴ Department of Orthopaedic Surgery, Osaka International Cancer Institute, Osaka, Japan.
⁵ Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Japan.
⁶ QST Hospital, National Institute for Quantum Science and Technology, Chiba, Japan.

PMID: 37045686
DOI: 10.1016/j.jos.2023.03.016

Abstract

Background: It is known that several complications are caused by local surgery after radiotherapy. Clinical reports that describe the postoperative complications associated with surgery after carbon ion radiotherapy are sparse. This study aimed to elucidate local surgery feasibility after carbon ion radiotherapy specifically for primary bone sarcomas.

Methods: The medical, surgical, and irradiation records of patients who had local surgery at the area irradiated with carbon ion beams between 2004 and 2018 were reviewed retrospectively to evaluate the feasibility and indication of local surgery after CIRT.

Results: There were eight patients who had 10 local surgeries at the irradiated sites among the 42 carbon ion radiotherapy patients. There were seven males and one female with a median age of 50 years (range 26-73 years). The reasons for surgery were three for skin toxicity and associated infection, five for bone collapse, and associated implant failure, and two for tumor regrowth. All surgical fields included the area of more than 60 Gy (RBE) irradiated dose. All three surgical cases caused by skin toxicity and associated infection had Grade I wound complication after surgery according to the Clavien-Dindo Classification.

Conclusion: Local surgery after CIRT appeared feasible in selected patients with primary bone sarcoma, especially for the patients with bone collapse and associated implant failure. However, infection and prescribed irradiation dose at the incision site must be carefully evaluated.

Keywords: Carbon ion radiotherapy; Complication; Prophylactic surgery; Salvage surgery; Unresectable bone sarcoma.