Daniel Indelicato, MD, University of Florida, Jacksonville, FL Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference, Methodist Healthcare-San Antonio

1. Radiotherapy in the Treatment of Sarcomas in Adolescents and Young Adults 2008 ACC Defensive Player of the Year, and his 2009 season was expected to make him an NFL first-round draft pick

2. No conflicts of interest to disclose

3. Scope of Problem in AYAs Sarcomas 15% Leukemia 14% Germ Cell Tumors 13% Brain Tumors 10% Thyroid Carcinoma 8% Melanoma 8% Other 9% Lymphoma 23% Bone sarcoma 8% Soft tissue sarcoma 7%

4. How Radiation is Perceived Seminars in Oncology, 2009 Number of times “radiation” is mentioned relative to side effects: 11 Number of times “radiation” is mentioned as a treatment modality: 7

8. Value of RT for Adolescent and Young Adult Bone Sarcomas Remember: Sarcoma type determines radiosensitivity, disease control outcomes

13. Value of RT for Adolescent and Young Adult Soft Tissue Sarcomas

14. “ The management of this condition should be radical surgery and that no help should be expected from radiotherapy either as a pre- or postoperative procedure” - Dr. Ralston Paterson (1963) Holt Radium Institute at the Christie Cancer Hospital, founded by Ralston Patterson Soft Tissue Sarcoma: Then

15. Annals of Surgery, 1982 27 pts WLE+RT 16 pts Amputation 43 pts High grade STS Extremity

16. Level I Data: General Population

22. Bone Tumors Soft Tissue Sarcoma

23. Challenges of Using Radiation for AYA Sarcoma Remember: Sarcoma location dictates treatment side effects and complications

26. Local Management of Lower Extremity Ewing Tumors at the University of Florida: 1970-2006 (Indelicato 2007)

27. 1987 1969 65 Gy 60 Gy + 20 years

31. Musculoskeletal Complications of Radiation Treatment

32. Bone Complications of Radiation Treatment Traditional risk factors for fracture: ● radiation dose (mean dose >37 Gy) ● periosteal stripping ● female gender Pathogenesis: microvascular supply; osteoclast alteration? Rate of fracture in patients with Ewing sarcoma of weight bearing bone: 30% Slipped femoral capital epiphysis radiation injury to the proximal femoral growth apparatus + weight-bearing stress After only 12 Gy

42. Guidelines: Minimizing Toxicity in AYA Sarcoma Male with synovial sarcoma of the proximal medial thigh Protons Photons

44. "He hasn't lost anything“ - ESPN commentator Curt Warner 9/6/2010

45. Thank you Questions?