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. 2020 Apr 16;5(2):e000635. doi: 10.1136/esmoopen-2019-000635

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© Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, any changes made are indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Sacrum metastases not amenable to surgical resection are treated with SBRT and 223-Ra with improvement in the patient’s quality of life. (A) A 15-year-old patient (patient B in tables 1–3) with osteosarcoma recurrence in the right sacrum evidenced on SPECT. This patient was treated with SBRT and six cycles of 223-Ra. The patient was able to continue to attend school while undergoing SBRT. The post-treatment SPECT revealed reduced radiotracer uptake in the sacral disease. (B) A 17-year-old patient (patient K in tables 1–3) with osteosarcoma recurrent in the left sacrum associated with severe pain. This patient was treated with SBRT and six cycles of 223-Ra. Again, the post-treatment SPECT showed reduced radiotracer uptake in the sacral disease. Complete and durable resolution of pain without local relapse was observed in both patients. PTV, planning target volume; SBRT, stereotactic body radiation therapy; SPECT, single-photon emission computed tomography.