PubMed · 7779603
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A Santoro, G Bonadonna. 1994. Soft tissue and bone sarcomas.. https://pubmed.ncbi.nlm.nih.gov/7779603/
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BACKGROUND: In the United States, at least half of the patients who are irradiated are done so with palliative intent. The most common presentation is the patient with bone metastasis. However, because current scientific outcome and technology techniques are insufficient for the creation of guidelines, the American College of Radiology created a work group of experts to formulate appropriateness criteria for the irradiation of bone metastasis. METHOD: A MEDLINE search to help review the community practices was initiated. Twenty-five clinical vignettes were reviewed by a panel of experts. Recommendations for each vignette were prioritized and selected based on choices proposed by panel members. RESULT: Doses in the range of 20 Gy in 5 fractions, 30 Gy in 10 fractions, or 35 Gy in 14 fractions are acceptable in most circumstances. Daily doses > 4.0 Gy were not commonly suggested. CIRCUMSTANCES: To determine optimal dose fractionation schemes, more emphasis needs to be put on the life expectancy of the patients. Rapid schedules are acceptable in patients with short life expectancy (i.e., < 3 months), but this hypothesis needs to be tested. Further research to better define the clinical indications of hemibody irradiation and strontium-89 is recommended.
PURPOSE: Radiotherapy plays a major role in the management of painful osseous metastases. This survey was conducted to study the current approaches to this clinical problem in the radiotherapy community. METHODS AND MATERIALS: A questionnaire was sent to 2500 members of the American Society for Therapeutic Radiology and Oncology. It consisted of 30 multiple-choice questions regarding four hypothetical clinical scenarios likely to be encountered in daily practice. Questions related to the technique of choice [local field (LF) vs. hemibody radiotherapy (HBI)], the use of systemic radionuclides (SR), fractionation schemes, dose, the integration of modalities, and the follow-up of these patients. The analysis is based on 817 (33%) responses received regarding 3268 cases. RESULTS: Local field is the most common form of therapy. Overall, LF was used, alone or in combination with other forms of therapy, in 54% and 74% of patients, respectively. LF was used more frequently in patients with breast cancer than in patients with prostate cancer (79% vs. 45%; p = 0.0001). Long fractionation schemes were used by 90% of physicians in 96% of cases. Short fractionation schemes were used by 7% of physicians in 4% of cases. This tendency was more pronounced in private practice than in the university or government/ multidisciplinary settings (p = 0.008) and in physicians starting their practice before 1982 (p = 0.05). The most common schedule was 30 Gy in 10 fractions, used by 77% of physicians in 64% of cases. HBI was used, alone or in combination with other forms of therapy, in 1% and 2% of patients, respectively. It was used more frequently in patients with prostate cancer than in patients with breast cancer (1.2% vs. 0.1%, respectively; p < 0.0001). SR were used alone or in combination with local-field irradiation in 21% and 40% of cases, respectively. SR were used more frequently in patients with prostate cancer than in those with breast cancer (28% vs. 0.2%, respectively;p < 0.00001). The most common radionuclide in use is Sr-89 (99%) at a dose of 4 mCi (73%) or 10.8 mCi (26%). CONCLUSIONS: Although LF remains the mainstay of therapy, our results demonstrate the emergence of a new pattern of practice: LF to the painful site in combination with SR for clinically occult metastases. Despite an ongoing academic debate regarding fractionation schemes, the vast majority of American practitioners advocate long schedules.
Both tumor suppressor genes p53 and p16(INK4A) play a crucial role in the control of cell cycle and tumor development. In this study 19 malignant fibrous histiocytomas of the bone (MFH-b), a very rare sarcoma entity, were investigated for mutations in p53 and p16 genes by a PCR-SSCP-sequencing analysis. In the tumor samples two p53 mutations and two polymorphisms (one in the p53 gene and one in the p16 gene) were found. The occurrence rate for p53 mutations and the absence of p16 mutations in MFH-b are comparable to the findings for MFH of soft tissues (MFH-st) and osteosarcomas, suggesting that p53 rather than p16 may play a role in tumorigenesis of MFH-b.