Would you recommend post operative radiation in an adult patient with a thoracic spine osteosarcoma?

The following answer is extrapolated from AOST2032 which is a pediatric clinical trial but is relevant to the question at hand.

This case touches upon the concepts outlined in the AOST2032 research protocol for osteosarcoma radiation therapy. While acknowledging this is just one protocol and not a source of direct treatment recommendations, it's interesting to note their approach in a postoperative setting with positive margins.

The protocol advocates for a phased reduction in target volume, st...

There are many details that would be important to know here (location of positive margin; can the positive margin be revised; what chemo given; % necrosis/response to chemo; subtype, etc) but from first principles, absolutely yes to adjuvant RT. Adjuvant RT has shown benefit in H&N osteosarcoma with less than secure margins, and the principles are similar in the spine (margins often close or positive; critical anatomic location; salvage of a local recurrence is challenging, etc). The AOST2032 ap...