The role of EBI as primary or adjunct treatment is still
controversially discussed. Despite the relatively high risk of
radiation-induced malignancy [36–40], it is still used by
many. Leggon et al. published a rate of secondary sarcoma of
11% of patients with pelvic or sacral tumors [12], and Sanjay
et al. of 25% in GCT of the pelvis [14]. One of our spine cases
(case 3) and one of our sacrum cases (case 9) received EBI for
adjuvant treatment of a local recurrence. Three patients with
sacral tumors received EBI as an adjunct to initial surgery
(cases 12, 15, 16), three as primary treatment (cases 17–19).
None of them developed a secondary malignancy so far but
as the risk increases with time [41] it might occur at a longer
followup. When surgery is an option irradiation should be
avoided. Even in inaccessible tumors we by now prefer SAE
before considering EBI