Multidisciplinary approach with stereotactic reirradiation to oligoprogressive spinal metastases from dedifferentiated osteosarcoma: a case report

Background Stereotactic body radiotherapy (SBRT) has emerged as a promising therapeutic approach for vertebral metastases, achieving high local control and safety. However, evidence on spinal reirradiation with SBRT is limited, and data are especially scarce for radioresistant histologies such as osteosarcoma. Case report We present the first case of a second reirradiation in radioresistant metastatic osteosarcoma, with each consecutive course of radiotherapy administered at an interval of at least 6 months. After multiple surgical interventions in the cervical and thoracic spine and three lines of chemotherapy, the patient demonstrated local progression in the C-Th region of the spine, which was successfully treated with a third SBRT, achieving a partial response without any acute adverse events. Conclusions SBRT for spinal metastases reirradiation has seen a growing trend in recent years. Preliminary studies, as well as the following case report, demonstrate its usefulness, effectiveness, and safety in a carefully selected group of patients. In this particular instance, even a third SBRT course has been demonstrated to yield clinical benefits and can be executed safely, provided that it is administered in accordance with proper technical regimens and critical organ sparing strategies.