A case of radiation-induced osteosarcoma treated effectively by boron neutron capture therapy
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CASE REPORT
Open Access
A case of radiation-induced osteosarcoma treated effectively by boron neutron capture therapy Gen Futamura1, Shinji Kawabata1, Hiroyuki Siba1, Toshihiko Kuroiwa1, Minoru Suzuki2, Natsuko Kondo2, Koji Ono2, Yoshinori Sakurai3, Minoru Tanaka4, Tomoki Todo4 and Shin-Ichi Miyatake5*
Abstract We treated a 54-year-old Japanese female with a recurrent radiation-induced osteosarcoma arising from left occipital skull, by reactor-based boron neutron capture therapy (BNCT). Her tumor grew rapidly with subcutaneous and epidural extension. She eventually could not walk because of cerebellar ataxia. The tumor was inoperable and radioresistant. BNCT showed a marked initial therapeutic effect: the subcutaneous/epidural tumor reduced without radiation damage of the scalp except hair loss and the patient could walk again only 3 weeks after BNCT. BNCT seems to be a safe and very effective modality in the management of radiation-induced osteosarcomas that are not eligible for operation and other treatment modalities.
Introduction The incidence of radiation-induced sarcoma has been estimated to be between 0.03% and 0.3% of all patients who have received radiation therapy [1,2]. Radiationinduced osteosarcomas are being encountered more frequently as the use of radiation therapy becomes more common, and the number of long-term cancer survivors has increased. The original diagnostic criteria for radiation-induced osteosarcomas were proposed in 1948 by Cahan et al. [3], and a short latency period was recently accepted for these tumors [1,4,5]. The diagnosis of radiation-induced osteosarcoma must fulfill the following four criteria: (1) the sarcoma must arise in a previously irradiated field, (2) the sarcoma must be histologically distinct from the original neoplasm, (3) there was no evidence of tumor in the involved bone at the time of initial irradiation, and (4) there must be a latency period between the irradiation and the development of the sarcoma at least 3 years. Radiation-induced osteosarcoma of the head is a devastating complication of radiation therapy. It is very rare but aggressive, with high recurrence and a poor prognosis [6]. The median overall survival time was reported to be 29 months [1]. Osteosarcoma is thought to be radioresistant [7,8]. Therefore, complete surgical resection * Correspondence: [email protected] 5 Cancer Center, Osaka Medical College, Takatsuki, Japan Full list of author information is available at the end of the article
has been described as the most important prognostic factor [9] and the first choice of treatment for radiationinduced osteosarcoma. However, if complete surgical resection is difficult (as it was in the present case), adjuvant chemotherapy and radiotherapy should be considered. These therapeutic effects have thus far been found to be insufficient, however. We report here the case of a patient with recurrent radiation-induced osteosarcoma who was treated effectively by boron neutron capture therapy (BNCT). BNCT is based on the nuclear capture reaction
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