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Patients with osteoblastic metastases from high risk osteosarcoma continue to have a poor prognosis after progression from standard-of-care multi-agent chemotherapy. In a first-in-human dose escalation trial of bone targeted Radium 223 dichloride alpha-particle therapy in 18 patients with advanced osteosarcoma only 1 patient responded based on conventional Response Evaluation Criteria in Solid Tumors (RECIST). Na18F PET response Criteria in Solid Tumors(NAFCIST), based on Sodium fluoride-18 (Na18F) positron emission tomography (PET)-CT was developed to better evaluate bone specific response. To further appreciate the spatial and temporal heterogeneity of the partial or mixed responses, a radiomics method was developed. Analyses were performed with 18F-sodium fluoride positron emission tomography imaging studies before and after alpha-particle therapy. Radioactive 18F- -atom concentrations were measured in soft-tissues, in approximately 1000 concentration data points for 18F- per 1 cm3 metastatic tumor. Data was analyzed from the SUV intensity values, the histogram of intensities and entropy values. Radiomics may inform intra-tumoral and inter-tumoral heterogeneity in response of bone forming osteosarcoma to alpha particle therapy. Each patient (and each tumor) represents an "N of 1" case and warrants in depth analysis individually.

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BACKGROUND: Although osteoblastoma is an uncommon benign bone tumor, it sometimes behaves in a locally aggressive fashion. We herein report a case of recurrent lumbar spine osteoblastoma that was treated by repeated surgery and carbon ion radiotherapy. CASE PRESENTATION: A 13-year-old Japanese girl presented with left side lumbar pain. Computed tomography and magnetic resonance imaging of the lumbar spine demonstrated a tumorous lesion in the left side pedicle of L4. Although gross total resection of the mass, including the nidus, was performed in the initial surgery, recurrence was observed repeatedly in the short term and the pathological diagnosis of all of the resected tumors was conventional osteoblastoma. We finally performed carbon ion radiotherapy after the patient's 3rd palliative operation, and achieved a good outcome. No further recurrence has been observed in 10 years of follow-up. CONCLUSION: We performed carbon ion radiotherapy for a case of recurrent spinal osteoblastoma and achieved a good outcome without recurrence at 10 years after carbon ion radiotherapy treatment. To the best of our knowledge, this is the first case of osteoblastoma that was treated with carbon ion radiotherapy after multiple surgeries.

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OBJECTIVE: Osteoblastoma (OB) is a painful, rare, benign bone tumour usually observed in young populations, and this condition involves the spine in up to one-third of cases. We sought to focus on the minimally invasive treatment of spinal OB with radiofrequency ablation (RFA) under computed tomography (CT) guidance. When performed near the spinal cord, surgery can lead to instability of the spine, sometimes requiring additional interventions to stabilise the segments involved, and can cause the precocious onset of arthrosis or other degenerative diseases. The results were evaluated both clinically and with the aid of diagnostic imaging techniques during a 5-year follow-up study. MATERIALS AND METHODS: Eleven patients affected by spinal OB were treated in a single session with biopsy and CT-guided RFA. Pre- and post-evaluations of the patients were performed both clinically and with CT and magnetic resonance imaging (MRI). RESULTS: Complete success in terms of pain relief was achieved in all patients. Additional treatments were not required in any patients. There were no complications. During follow-up, neither complications nor pathological findings related to the treatment were observed. CONCLUSIONS: Our experience demonstrates that RFA for spinal OB is safe and effective. One of the main advantages of this technique is represented by its lower grade of invasiveness compared with that for potentially hazardous surgical manoeuvres.

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El osteoblastoma es un tumor óseo primario poco frecuente, que presenta una histología similar al osteoma osteoide. Aproximadamente el 40% se localiza en la columna, generalmente afectando a las estructuras posteriores vertebrales. Esta localización puede asociarse a escoliosis y a síntomas neurológicos. Su diagnóstico se realiza mediante la radiografía simple, la TAC, la RMN y los estudios radioisotópicos. La gammagrafía ósea demuestra un acúmulo aumentado del trazador. El tratamiento se basa en la resección de la lesión. Sin embargo, puede haber dificultad para localizar el nidus y la cirugía puede verse limitada debido a la proximidad de estructuras neurales. Presentamos el caso de un paciente con un osteoblastoma vertebral en el que se aplicó la cirugía radiodirigida para su tratamiento, utilizándose tanto una sonda de detección como una minigammacámara. La técnica permitió la localización exacta del tumor y la extirpación efectiva del nidus(AU)

Osteoblastoma is an uncommon primary neoplasm of the bone, with histological manifestations similar to osteoid osteoma. Approximately 40% of them are located in the spine, usually involving the posterior structures. This location may be associated with scoliosis and neurologic manifestations. Diagnostic imaging includes simple X-ray, CT scan, MRI and radionuclide studies. Bone scintigraphy demonstrates an increased radiotracer accumulation. The standard treatment consists of open intralesional resection. Nevertheless, localization of nidus may be difficult and bone resection may be limited due to the proximity of the neural structures. We present the case of a patient with a spinal osteoblastoma in whom the use of radioguided surgery was performed through gamma probe and mini gamma camera. This technique made it possible to accurately locate the tumor and perform an effective removal of the nidus(AU)

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Proton radiation therapy involves accurate delivery of proton beams to targets inside the body without direct visual control of the internal anatomy. Targeting of the tumor and avoidance of critical structures within the patient have to be both accurate and precise to achieve the desired therapeutic results. Good understanding of proton radiation delivery and patient alignment concepts in the treatment room is essential to achieve this goal. This overview article presents treatment room concepts that will ensure precise proton beam delivery and, at the same time, guarantee an efficient patient throughput. Concepts discussed include effective patient immobilization, image-guided alignment verification, appropriate training of radiotherapists, and the physician's integrative role in understanding the complex spatial relationships between tumor, organs at risk, treatment beam configuration, and application of proton radiation dose. It will be demonstrated that in addition to the technical armamentarium, now commonplace in modern radiation oncology departments, the interaction between radiation oncologist, medical physicist and radiotherapist is important for efficient operation of a proton treatment facility.

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Osteoblastoma agressiva is not often bone tumor, only locally malignant. There are not articles, describing extra skeleton localization. Authors presented case of 45 year old patient, who was treated because of Aggressive Osteoblastoma localized in larynx. Patient has received operation and irradiation treatment. The tumor localization and patients age--more than 35 year are unusual.

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Osteoblastoma is a rare primary bone tumor that is curable by complete excision. There are few data about the effectiveness of chemotherapy or radiotherapy in the treatment of recurrent osteoblastoma. We report a 13-year-old girl wit recurrent osteoblastoma who, after in complete surgical excision, responded to treatment with radiotherapy and later with chemotherapy. Surgery remains the treatment of choice for osteoblastoma. Radiotherapy and chemotherapy either alone or together may be useful in selected patients with recurrent, aggressive tumor or in patients with surgically unresectable disease.

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