Radiation therapy in the treatment of difficult giant cell tumors

Thirteen patients with giant cell tumors of bone have been treated by radiation therapy because surgery was not feasible or unacceptably disfiguring. Seven patients were treated for primary giant cell tumors of the bone, four for recurrent disease, and three for metastasis (one presented with both distant metastasis and local recurrence after primary surgery). The follow-up time ranged from 18 months to 13 years, with a mean of 6.5 years. All patients except one are alive. Local control was achieved in 11 patients (85%). One patient whose tumor was located in the sacrum had no gross response and at 5 months was subjected to a partial sacrectomy. A second patient had local regrowth 1 year after treatment; salvage surgery was successful. There have been no long-term complications of radiation therapy. This study confirms that for patients with giant cell tumor of bone, radiation therapy offers an effective alternative to complex or difficult surgery and constitutes a good treatment method to medically inoperable patients

Gorham's massive osteolysis: The role of radiation therapy and a review of the literature

Purpose : This paper reviews the natural history and management of patients with Gorham's disease and presents four cases treated at The Massachusetts General Hospital since 1965. Gorham's disease is characterized by localized endothelial proliferation which results in destruction and resorption of bone. The etiology is undefined. There is no evidence of a malignant, neuropathic, or infectious component. This disease is progressive in most patients, but in occasional instances the process has been noted to be self-limited. The principal treatment modalities are surgery and radiation therapy. Methods and Material : Since 1965, four patients with Gorham's Disease have been treated at the Massachusetts General Hospital. Three received definitive radiation therapy in doses ranging from 31.5 to 45 Gy. The fourth patient underwent surgery primarily. Results : Three patients are currently alive and fully functional with no evidence of disease at last follow-up. The fourth patient died of progressive disease despite treatment with both radiation therapy and surgery. Conclusion : The prognosis for patients with Gorham's disease is generally good unless vital structures are involved. Due to the rarity of this entity, there is no standard therapy. Definitive radiation therapy in moderate doses (40–45 Gy in 2 Gy fractions) appears to result in a good outcome and few long-term complications

Dermatofibrosarcoma protuberans treated with radiation therapy

Dermatofibrosarcoma Protuberans is an uncommon soft tissue tumor that is locally aggressive, prone to recur locally following excision, and has a low propensity for metastasis. Ten patients have received radiation (both external beam and interstitial implant) as part of, or as their only treatment, at Massachusetts General Hospital from 1979–1987. Three patients received radiation alone (66.7–75 Gy) for gross palpable disease. One patient has slowly regressing nodules at 33 months; the other two had complete regression and are free of disease at 24 and 26 months posttreatment. Seven patients received radiation in conjunction with surgery. One received both pre-operative and postoperative radiation and six received postoperative radiation (60–67 Gy) for microscopic residual disease following resection. Six of these seven patients are free of disease 16 to 105 months following treatment. One patient, with diffuse microscopic tumor infiltration of the scalp, had a local recurrence within the radiation field 16 months following 64.4 Gy. There has been no significant treatment related morbidity. Even though the present experience is limited and the follow-up brief, it does suggest that radiation can be considered a viable therapeutic option in the patient who has a lesion that is not resectable

Metastatic ependymoma of the sacrum

Ependymomas originating in the sacrum or extraspinal parasacral soft tissues are rare tumors. The majority are of the myxopapillary type and may be locally destructive. Even though metastases are not uncommon in retrosacral ependymomas, they have been rarely described in intrasacral locations. A case is reported of a large intrasacral ependymoma with metastases to several vertebrae. Radiologic and pathologic studies are presented. Treatment options are discussed