The most important component of curative treatment for patients with primary bone sarcomas is local therapy of the primary tumour. For Ewing’s sarcoma, surgery is the optimal local therapy, but radiotherapy can be used as a potentially curative treatment, when surgery cannot be used. Until relatively recently, radiotherapy for more radio-resistant bone sarcomas (osteosarcoma, chondrosarcoma, chordoma, spindle cell sarcoma of bone) has often not been very effective, as it is difficult to deliver a high enough dose to kill the tumour without causing unacceptable side effects to nearby normal tissues.

 

          In recent years there have been important advances in new radiotherapy technologies, which have radically changed what is achievable both for tumour control and reduction in side effects. Techniques such as intensity-modulated radiotherapy (IMRT) and proton radiotherapy offer the opportunity to increase radiotherapy doses, improve treatment efficacy, and reduce side effects of treatment. IMRT allows better shaping of a radiotherapy beam to allow it to treat the tumour more accurately, while reducing the dose to normal tissue. Proton beam radiotherapy uses proton particles that deposit their energy over a small focussed area, allowing treatment to high doses because of excellent sparing of adjacent normal tissues. To date, there has been little research into the use of either of these technologies in primary bone sarcomas. It is not clear how and for whom these technologies should be used to the best advantage or whether cure rates for inoperable radio-resistant bone sarcomas could be improved by integrating IMRT/protons into treatment protocols.

 

            The UK government has committed to opening 2 proton centres in the UK, planned to start treating patients in 2017, one in Manchester, and the other at UCLH in London. This research fellowship, funded by the Bone Cancer Research Trust, explores the roles of IMRT and protons in the treatment of primary bone sarcomas through a radiotherapy double planning study comparing the 2 techniques for individual tumours, to find out which technique is best for particular tumours. In addition a clinical study to treat patients with spine and pelvic bone sarcomas who need radiotherapy as their local therapy, aims to formally measure the effectiveness of IMRT and its side effects for these patients. This preparatory work is essential to enable us to treat patients effectively and appropriately when the proton centre opens.

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