Osteosarcoma of Cervical Spine: Report of a Case Treated with Hadrontherapy


  • Leonello Tacconi Neurosurgical Unit, Azienda Universitaria Integrata, Trieste, Italy
  • Gennaro D’acunzi Neurosurgical Unit, ASL Salerno, Italy
  • Raffaele Fristachi UOC Anatomia Patologica, ASL Salerno, Italy
  • Filippo Aquila Neurosurgical Unit, Azienda Universitaria Integrata, Trieste, Italy




Osteosarcoma, sarcomas, traditional radiotherapy, protom beam therapy, hadrontherapy.


Sarcomas are rare tumours that commonly derive from neoplastic transformation of mesenchymal tissues. Only a small percentage of these malignancies are located in the spine. The gold standard of treatment is a multidisciplinary approach with the surgery being the most important tool. An en-bloc resection with free margins followed by radiotherapy seems to assure the best overall survival. Among the newest treatment modalities, certainly, the adrontherapy is the most interesting and promising kind of radiotherapy that uses the physical bullet properties (Bragg peak) of protons such as carbon ions to treat lesions. We present a case of a gentleman with a C2-C3 low grade osteosarcoma treated, after a biopsy tissue sample, with hadrontherapy alone. At 6 years follow up the tumour seems to be well under control.


Stiller CA, Trama A, Serraino D, et al. Descriptive epidemiology of sarcomas in Europe: Report from the RARECARE project. Eur J Cancer 2013; 49(3): 684-695. https://doi.org/10.1016/j.ejca.2012.09.011

Sciubba DM, De la Garza Ramos R, Rory Goodwin C, et al. Clinical, surgical, and molecular prognostic factors for survival after spinal sarcoma resection. Neurosurg Focus 2016; 41(2): E9.

Denaro L, Longo UG, Di Martino AC, Maffulli N, Denaro V. Screw migration and oesophageal perforation after surgery for osteosarcoma of the cervical spine. BMC Musculoskelet Disord 2017; 18(1): 1-8. https://doi.org/10.1186/s12891-017-1906-5

Bielack SS, Hecker-Nolting S, Blattmann C, Kager L. Advances in the management of osteosarcoma. F1000Research 2016; 5(0): 2767. https://doi.org/10.12688/f1000research.9465.1

Bielack SS, Wulff B, Delling G, et al. Osteosarcoma of the trunk treated by multimodal therapy: Experience of the cooperative osteosarcoma study group (COSS). Med Pediatr Oncol 1995; 24(1): 6-12. https://doi.org/10.1002/mpo.2950240103

Chen YM, Gokavarapu S, Shen QC, et al. Chemotherapy in head and neck osteosarcoma: Adjuvant chemotherapy improves overall survival. Oral Oncol 2017; 73(September): 124-131.

Frisch S, Timmermann B. The Evolving Role of Proton Beam Therapy for Sarcomas. Clin Oncol 2017; 29(8): 500-506. https://doi.org/10.1016/j.clon.2017.04.034

Matsumoto K, Imai R, Kamada T, et al. Impact of carbon ion radiotherapy for primary spinal sarcoma. Cancer 2013; 119(19): 3496-3503. https://doi.org/10.1002/cncr.28177

Matsumoto K, Nakamura K, Shioyama Y, et al. Treatment planning comparison for carbon ion radiotherapy, proton therapy and intensity-modulated radiotherapy for spinal sarcoma. Anticancer Res 2015; 35(7): 4083-4090.

Pommier P, Sunyach MP, Hu Y, et al.

Tuan J, Vischioni B, Fossati P, et al. Initial clinical experience with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO). J Radiat Res 2013; 54(SUPPL.1).

Chan KY, Sun TF, Kam KM, Shing MK, Poon WS. Cervical spinal osteosarcoma in an adolescent. J Clin Neurosci 2012; 19(8): 1172-1174. https://doi.org/10.1016/j.jocn.2011.09.035

Breakey RWF, Crowley TP, Anderson IB, Milner RH, Ragbir M. The surgical management of head and neck sarcoma: The Newcastle experience. J Plast Reconstr Aesthetic Surg 2017; 70(1): 78-84. https://doi.org/10.1016/j.bjps.2016.09.026

Ravindra VM, Eli IM, Schmidt MH, Brockmeyer DL. Primary osseous tumors of the pediatric spinal column: Review of Pathology and Surgical Decision Making. Neurosurg Focus 2016; 41(August): 1-14.

Clarke MJ, Price DL, Cloft HJ, et al. En bloc resection of a C-1 lateral mass osteosarcoma: Technical Note. JNS Pediatr 2016; 18(July): 46-52.

Boriani S, Weinstein JN, Biagini R. Primary bone tumors of the spine. Terminology and surgical staging. Spine (Phila Pa 1976) 1997; 22(9): 1036-1044. https://doi.org/10.1097/00007632-199705010-00020

Enneking WF, Spanier SS, Goodman MA. The Classic: A System for the Surgical Staging of Musculoskeletal Sarcoma. Clin Orthop Relat Res 2003; 415(415): 4-18. https://doi.org/10.1097/01.blo.0000093891.12372.0f

Tomita K, Kawahara N, Kobayashi T. Surgical Strategy for Spinal Metastases. Spine (Phila Pa 1976) 2001; 26(3): 298-306. https://doi.org/10.1097/00007632-200102010-00016

Rao G, Suki D, Chakrabarti I, et al. Surgical management of primary and metastatic sarcoma of the mobile spine. J Neurosurg Spine 2008; 9(2): 120-128. https://doi.org/10.3171/SPI/2008/9/8/120

Smith RB, Apostolakis LW, Karnell LH, et al. National Cancer Data Base report on osteosarcoma of the head and neck. Cancer 2003; 98(8): 1670-1680. https://doi.org/10.1002/cncr.11716

Weber U KG. Comparison of Carbon Ions Versus Protons : The Cancer Journal. Cancer J 2009; Jul-Aug; (15): 325-332. https://doi.org/10.1097/PPO.0b013e3181b01935




How to Cite

Leonello Tacconi, Gennaro D’acunzi, Raffaele Fristachi, & Filippo Aquila. (2018). Osteosarcoma of Cervical Spine: Report of a Case Treated with Hadrontherapy . Journal of Cancer Research Updates, 7(3), 97–101. https://doi.org/10.6000/1929-2279.2018.07.03.5