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Osteosarcoma is a primary malignant tumor that arises from the bone and is observed commonly at a relatively young age [1]. Therapy for operable osteosarcoma consists of the combination of operation and chemotherapy, and radiation therapy is thought to be relatively ineffective [2]. However, radiation therapy in combination with chemotherapy is chosen for cases of inoperable osteosarcoma [3]. Three-drug regimens, such as methotrexate, doxorubicin, and cisplatin, have been reported to show a better outcome concerning the 5-year event-free survival or overall survival than two-drug regimens in chemotherapy for osteosarcoma [4]. However, kidney injury due to chemotherapy drugs is reported to occur more frequently with cisplatin, ifosfamide, and methotrexate than with doxorubicin [5]. Radiation-associated kidney injury was reported to be caused by 10to 20-Gray total body irradiation [6]. Compared with photons, carbon ions provide a higher linear energy transfer and larger relative biological effectiveness (RBE). Carbon ion radiotherapy (CIRT) is suitable for local irradiation and is reported to be effective for unresectable osteosarcoma of the spine [7]. We herein report a case of chronic kidney injury associated with carbon ion radiotherapy and chemotherapy for inoperable osteosarcoma. Case Presentation

Thrombotic Microangiopathy Associated with Carbon Ion Radiotherapy and Chemotherapy for Osteosarcoma: a Case Report