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Malignant Pediatric Bone Tumors - Treatment & Management pp 109–124Cite as

Radiation Management

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Part of the book series: Pediatric Oncology ((PEDIATRICO))

Abstract

In 1921 when James Ewing first described the case of a “round cell sarcoma” discovered in the radius of a 14-year-old girl, he was surprised to see the rapid resolution of tumor following application of radium (Ewing 1921). “The prompt recession under radium was also quite unlike our experience with osteogenic sarcoma. With the recession of the tumor the shaft was well restored and normal function regained. The patient left the hospital with instructions to return weekly for observation, which was continued for several months.” Since that time, radiation therapy has played an integral role in the management of Ewing sarcoma. A report on 50 children treated at Massachusetts General Hospital between 1930 and 1952 documented sustained 5-year local control in 15 of 22 patients who received wide-field irradiation (Wang and Schulz 1953). Cure was achieved in four of these individuals. This was in contrast to those who underwent primary surgical resection, where only 1 of 10 patients was alive 5 years later. The authors emphasized the radiosensitive nature of the tumor, favoring radiotherapy over a potentially mutilating surgery. Indeed in an era where limitations in surgical technique permitted only radical resection or amputation, radiation alone comprised the standard of care for localized disease (Shankar et al. 1999; Donaldson 1980; Bacci et al. 1989; Evans et al. 1991; Jenkin 1991; Kinsella et al. 1991). However, in light of considerable advances in orthopedic surgery and effective multi-agent chemotherapy over the past several decades, the precise role of radiotherapy in a multidisciplinary setting continues to evolve, and the optimal approach to ensuring local control remains controversial (Shankar et al. 1999; Burgert et al. 1990; Pisters et al. 2007; Grier et al. 2003; McGovern and Mahajan 2012; Dunst et al. 1995).

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Authors and Affiliations

  1. Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, 410 West 10th Avenue, Columbus, OH, 43210, USA

    Ashley Sekhon MD, Karl Haglund MD, PhD & Michael Guiou MD

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  1. Ashley Sekhon MD
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  2. Karl Haglund MD, PhD
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Correspondence to Michael Guiou MD .

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  1. Division of Pediatric Hematology/Oncology/Blood and Marrow Transplantation, Nationwide Children’s Hospital, Columbus, Ohio, USA

    Timothy P. Cripe

  2. Division of Pediatric Hematology/Oncology/Blood and Marrow Transplantation, Nationwide Children’s Hospital, Columbus, Ohio, USA

    Nicholas D. Yeager

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Sekhon, A., Haglund, K., Guiou, M. (2015). Radiation Management. In: Cripe, T., Yeager, N. (eds) Malignant Pediatric Bone Tumors - Treatment & Management. Pediatric Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-18099-1_7

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