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31 Romanian Journal of Orthopaedic Surgery and Traumatology 2018; Special Issue 1 ROMSOS, SROA © 2018 RADIOTHERAPY IN OSTEOSARCOMAS doi: 10.2478/rojost-2018-0042 R. Mitrică, L. Şerbănescu, O. Trifănescu “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Osteosarcoma represents a rare primary tumor of the bone, but it ranks 5th among children and adolescents. When diagnosed, many patients already have a disseminated disease at subclinical level. Current treatment includes surgery and chemotherapy. Radiotherapy is not commonly indicated

-5. Bernier J, Hall EJ, Giaccia A. Radiation oncology: a century of achievements. Nat Rev Cancer 2004; 4(9) : 737-47. Tubiana M, Eschwege F. Conformal radiotherapy and intensity-modulated radiotherapy-clinical data. Acta Oncol 2000; 39(5) : 555-67. Shinohara ET, Lu B, Hallahan DE. The use of gene therapy in cancer research and treatment. Technol Cancer Res Treat 2004; 3(5) : 479-90. Gridley DS, Slater JM. Combining gene therapy and radiation against cancer. Curr Gene Ther 2004; 4(3) : 231-48. Robson T, Worthington J, McKeown SR, Hirst DG. Radiogenic therapy

References [1] Alber, M. and F. Nusslin, 1999. An objective function for radiation treatment optimization based on local biological measures. Phys Med Biol, 44:479-493 [2] Alber, M., M. Birkner, W. Laub and F. Nusslin, 2000. Hyperion: An integrated IMRT planning tool. Proceedings of the XIII Conference on the use of Computers in Radiationtherapy. Hrsg. W. Schlegel, T. Bortfeld. Springer, Heidelberg, pp:46-48 [3] Carolyn, W., T.A. Nisbet, P. Mcgale and S.C. Darby, 2007. Cardiac exposures in breast cancer radiotherapy: 1950s-1990s. Int. J Radiation Oncology Biol

References 1. Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M, Licitra L. Major and minor salivary gland tumors. Crit Rev Oncol Hematol 2010; 74: 134-48. 2. Mendenhall WM, Morris CG, Amdur RJ, Werning JW, Villaret DB. Radiotherapy alone or combined with surgery for salivary gland carcinoma. Cancer 2005; 103: 2544-50. 3. Engels H, Wambersie A. Relative biological effectiveness of neutrons for cancer induction and other late effects: a review of radiobiological data. Recent Results Cancer Res 1998; 150: 54-87. 4. Laramore GE, Krall JM, Griffin TW, Duncan W

Radiat Oncol Biol Phys 1994; 30: 775-80. Eifel PJ, Donaldson SS, Thomas PRM. Response of growing bone to irradiation: A proposed late effects scoring system. Int J Radiat Oncol Biol Phys 1995; 31: 1301-7. Reisner ML, Viégas CM, Grazziotin RZ, Santos Batista DV, Carneiro TM, Mendonça de Araújo CM, et al. Retinoblastoma-comparative analysis of external radiotherapy techniques, including an IMRT technique. Int J Radiat Oncol Biol Phys 2007; 67: 933-41. Jiang GL, Tucker SL, Guttenberger R, Peters LJ, Morrison WH, Garden AS, et al. Radiation induced injury to the

. Kingham TP, Karakousis G, Ariyan C. Randomized clinical trials in melanoma. Surg Oncol Clin N Am 2010; 19 : 13-31. Paterson R. Classification of tumours in relation to radiosensitivity. Br J Radiol 1933; 6 : 218-33. Delaney G, Barton M, Jacob S. Estimation of an optimal radiotherapy utilization rate for melanoma. A review of the evidence. Cancer 2004; 100 : 1293-301. Overgaard J, Overgaard M, Hansen V, von der Maase H. Some factors of importance in the radiation treatment of malignant melanoma. Radiother Oncol 1986; 5 : 183-92. Bentzen SM, Overgaard J

References 1. Vatanasapt V, Sriamporn S, Vatanasapt P. Cancer control in Thailand. Jpn J Clin Oncol. 2002; 32:S82-91. 2. Urego M, Flickinger JC, Carr BI. Radiotherapy and multimodality management of cholangiocarcinoma. Int J Radiat Oncol Biol Phys. 1999; 44:121-6. 10.1016/S0360-3016(98)00509-4 3. Crane CH, Macdonald KO, Vauthey JN, Yehuda P, Brown T, Curley S, et al. Limitations of conventional doses of chemoradiation for unresectable biliary cancer. Int J Radiat Oncol Biol Phys. 2002; 53:969-74. 4. Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et

References Ringborg U, Bergqvist D, Brorsson B, Cavallin-Ståhl E, Ceberg J, Einhorn N, et al. The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of radiotherapy for cancer including a prospective survey of radiotherapy practice in Sweden 2001—summary and conclusions. Acta Oncol 2003; 42: 357-65. McGinn CJ, Shewach, DS, Lawrence TS. Radiosensitizing nucleosides. J Natl Cancer Inst 1996; 88: 1193-203. Wachsberger P, Burd R, Dicker AP. Improving tumor response to radiotherapy by targeting angiogenesis signaling pathways

part of treatment for early breast cancer with a significant impact on survival of breast cancer patients. 2 Besides its treatment effect, it also has side effects. Among them, one of the most important is cardiotoxicity. This is of special concern, because in its severe form it is life-threatening, instead of breast cancer itself. Radiotherapy of the breast cancer, especially of the left breast, almost always involves some incidental irradiation of the heart. It can result in a range of cardiotoxic effects including coronary artery disease, cardiomyopathy

], [ 5 ]. In addition, it has been reported that when vitamin D is used in combination with radiotherapy (RT), it decreases the toxicity due to radiotherapy and increases the effect of radiotherapy [ 6 ]. Mechanism of action of vitamin D in cancer The basic effect of vitamin D is on calcium and phosphorus metabolism and bone mineralization. At the same time, it provides immune tolerance and immunosuppressant by influencing many immune system cells. It changes dendritic cell differentiation and functions. It enhances T cell activity that is necessary for