J Korean Assoc Oral Maxillofac Surg.  2021 Aug;47(4):315-320. 10.5125/jkaoms.2021.47.4.315.

Carbon-ion radiotherapy in osteosarcoma of the mandible: a case report

• Ha TW
• Park S
• Youn MY
• Kim DW
• Kim HJ

• KMID: 2519828
• DOI: http://doi.org/10.5125/jkaoms.2021.47.4.315

Abstract

Carbon-ion radiotherapy (CIRT) is on the rise as a treatment choice for malignant tumor. Compared to conventional radiotherapy, particle beams have different physical and biological properties. Particle beam provides a low entry dose, deposits most of the energy at the endpoint of the flight path, and forms an asymptotic dose peak (the “Bragg peak”). Compared to protons, carbon with its larger mass decreases beam scattering, resulting in a sharper dose distribution border. We report a 50-year-old male who underwent CIRT without surgical resection on osteosarcoma of the mandible. After CIRT, the patient’s pain was gone, and the malignant mass remained stable with accompanying necrosis. Nine months later, however, magnetic resonance imaging demonstrated progression of the left mandibular osteosarcoma with pulmonary metastases. After multidisciplinary discussion, concurrent chemoradiotherapy was conducted. While necrotic bone segments came out of the mandible during subsequent periodic outpatient visits, the tumor itself was stable. Thirty months after his first visit and diagnosis, the patient is waiting for chemotherapy. Although CIRT is superior in treating radioresistant hypoxic disease, CIRT is in its infancy, so care must be taken for its indications and complications.

Keyword

Osteosarcoma; Heavy ion radiotherapy; Radiotherapy; Head and neck neoplasms

Figure

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  Fig. 1 Measured tumor size in magnetic resonance imaging. A. October 2016, before carbon-ion radiotherapy (CIRT). 4.5 cm×3.9 cm. B. April 2017, 3 months after CIRT. 7.2 cm×5.3 cm. C. October 2017, 9 months after CIRT. No change in overall size of tumor. D. October 2018, 21 months after CIRT. Suspected recurrence of tumor.

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  Fig. 2 A. Apirl 2017. The patient had newly-developed symptoms such as dysesthesia on left buccal cheek, limited mouth opening, xerostomia, oral ulcers and ipsilateral otitis externa with hearing loss. B. January 2018. Peroral biopsy of ulcerative soft tissue mass was done.

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  Fig. 3 A. November 2016. Mass with increased 18F-fluorodeoxyglucose (FDG) uptake in the left masticator space, suggesting malignancy. No sign of lymph node or distant metastasis was observed. B. October 2017, 9 months after carbon-ion radiotherapy (CIRT). C. February 2018, 13 months after CIRT. D. October 2018, 21 months after CIRT. Recurrent tumor with metastatic lymphadenopathy was suspected.

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  Fig. 4 A comparison of the physics of X-ray and particle beam doses. The proton and carbon ion beams have a significantly lower entrance dose, and no exit dose.

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  Fig. 5 A. October 2016. Osteolytic lesion on left mandibular condyle with pathologic fracture. B. March 2018. C. November 2018. Necrotic change was noted. D. January 2019.

Reference

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