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Whole lung irradiation for completely responding pulmonary metastases in pediatric Ewing sarcoma

    Hagar Elghazawy

    *Author for correspondence:

    E-mail Address: hagar.ibrahim@57357.org

    Children’s Cancer Hospital, Egypt (CCHE), Cairo, Egypt

    Department of Clinical Oncology, Ain Shams University, Cairo, Egypt

    ,
    Azza Nasr

    Children’s Cancer Hospital, Egypt (CCHE), Cairo, Egypt

    Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo, Egypt

    ,
    Iman Zaky

    Children’s Cancer Hospital, Egypt (CCHE), Cairo, Egypt

    Department of Radiodiagnosis, National Cancer Institute, Cairo University, Cairo, Egypt

    ,
    Manal Zamzam

    Children’s Cancer Hospital, Egypt (CCHE), Cairo, Egypt

    Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

    ,
    Ahmed Elgammal

    Children’s Cancer Hospital, Egypt (CCHE), Cairo, Egypt

    Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

    ,
    Nesma Farid

    Department of Research, Children’s Cancer Hospital, Egypt (CCHE), Cairo, Egypt

    &
    Mohamed S Zaghloul

    Children’s Cancer Hospital, Egypt (CCHE), Cairo, Egypt

    Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo, Egypt

    Published Online:https://doi.org/10.2217/fon-2020-0066

    Aim: Scarce data assessing the real value of whole lung irradiation (WLI) in Ewing’s sarcoma (ES) with lung-only metastasis, with published conflicting results. We studied the impact of WLI in a homogenous pediatric population. Materials & methods: Retrospective study evaluating the survival outcomes of WLI in these patients. Results: Out of 163 metastatic ES; 41 patients were eligible for WLI. 30 patients (73.1%) received WLI (+ve) while 11 patients (26.8%) did not receive WLI (-ve). Five-year event-free survival was statistically significant in WLI (+ve). Five-year pulmonary relapse-free survival showed trend for improvement with WLI (+ve), while 5-year overall survival was not statistically significant between the two arms. Conclusion: WLI added significantly to the long term clinical outcome of metastatic ES patients, with no irreversible toxicity.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

    References

    • 1. Stiller C, Bielack S, Jundt G et al. Bone tumors in European children and adolescents, 1978–1997. Report from the Automated Childhood Cancer Information System project. Eur. J. Cancer 42(13), 2124–2135 (2006).
    • 2. Uyeturk U, Helvaci K, Demirci A et al. Clinical outcomes and prognostic factors of adult’s Ewing sarcoma family of tumors: single center experience. Contemp. Oncol. (Pozn.) 20, 141–146 (2016). •• This study highlights the high propensity of Ewing’s sarcoma to metastasize to lungs.
    • 3. Cangir A, Vietti T, Gehan E et al. Ewing’s sarcoma metastatic at diagnosis results and comparisons of two intergroup Ewing’s sarcoma studies. Cancer 66(5), 887–893 (1990).
    • 4. Granowetter L, Womer R, Devidas M et al. Dose-intensified compared with standard chemotherapy for nonmetastatic Ewing sarcoma family of tumors: a children’s oncology group study. J. Clin. Oncol. 27(15), 2536–2541 (2009).
    • 5. Biswas B, Rastogi S, Khan S et al. Hypoalbuminaemia is an independent predictor of poor outcome in metastatic Ewing’s sarcoma family of tumors: a single institutional experience of 150 cases treated with uniform chemotherapy protocol. Clin. Oncol. 26(11), 722–729 (2014).
    • 6. Paulussen M, Ahrens S, Craft A et al. Ewing’s tumors with primary lung metastases: survival analysis of 114 (European intergroup) cooperative Ewing’s sarcoma studies patients. J. Clin. Oncol. 16(9), 3044–3052 (1998). • This study shows that 10 years event-free survival (EFS) for patients with Ewing’s sarcoma lung-only metastasis is significantly lower than localized disease (30 vs 48%, respectively) though significantly better than patients with extra-pulmonary metastasis (16%).
    • 7. Oberlin O, Rey A, Desfachelles A et al. Impact of high-dose busulfan plus melphalan as consolidation in metastatic Ewing tumors: a study by the Société Française des Cancers de l'Enfant. J. Clin. Oncol. 24(24), 3997–4002 (2006).
    • 8. Anderton J, Moroz V, Marec-Bérard P et al. International randomised controlled trial for the treatment of newly diagnosed EWING sarcoma family of tumours – EURO EWING 2012. Protocol.Trials. 21(1), 96 (2020).
    • 9. Luksch R, Tienghi A, Hall K et al. Primary metastatic Ewing’s family tumors: results of the Italian Sarcoma Group and Scandinavian Sarcoma Group ISG/SSG IV study including myeloablative chemotherapy and total-lung irradiation. Ann. Oncol. 23(11), 2970–2976 (2012). • In this prospective study, the 5-years overall survival (OS) and EFS reached 66 and 53%, respectively, for patients received high dose chemotherapy and whole lung irradiation (WLI).
    • 10. Dirksen U, Le Deley M, Brennan B et al. Efficacy of busulfan-melphalan high dose chemotherapy consolidation (BuMel) compared to conventional chemotherapy combined with lung irradiation in Ewing’s sarcoma (ES) with primary lung metastases: results of EURO-EWING 99-R2pulm randomized trial (EE99R2pul). J. Clin. Oncol. 34(Suppl. 15), 11001–11001 (2016). • Euro Ewing 99 study, which showed 3 years OS and EFS of 51.5 and 50.3%, respectively, in patients received standard chemotherapy and WLI.
    • 11. Bölling T, Schuck A, Paulussen M et al. Whole lung irradiation in patients with exclusively pulmonary metastases of Ewing tumors. Strahlenther. Onkol. 184(4), 193–197 (2008). • EICESS-92 study which showed no OS benefit of adding WLI.
    • 12. Bonchi L, Buwenge M, Cortesi A et al. Whole lung irradiation in patients with osteosarcoma and Ewing’s sarcoma. Anticancer Res. 38(9), 4977–4985 (2018). • Recent review which evaluated the role of WLI and included four studies (two studies were single arm) showing lack of significant impact of WLI on OS, while one study showed significant improvement in EFS and pulmonary relapse-free survival, and the other study did not show any improvement.
    • 13. Paulussen M, Ahrens S, Burdach et al. Primary metastatic (stage IV) Ewing tumor: survival analysis of 171 patients from the EICESS studies. Ann. Oncol. 9(3), 275–281 (1998).
    • 14. Nesbit M, Gehan E, Burgert E et al. Multimodal therapy for the management of primary, nonmetastatic Ewing’s sarcoma of bone: a long term follow-up of the first intergroup study. J. Clin. Oncol. 8(10), 1664–1674 (1990).
    • 15. Marinova L, Hristozova I, Mihaylova I et al. Protective, elective lung irradiation in non-metastatic Ewing’s sarcoma. Radiat. Prot. Dosimetry 165(1–4), 492–494 (2015).
    • 16. Spunt S, McCarville M, Kun L et al. Selective use of whole lung irradiation for patients with Ewing’s sarcoma family tumors and pulmonary metastases at the time of diagnosis. J. Pediat. Hematol. Oncol. 23(2), 93–98 (2001).
    • 17. Casey D, Alektiar K, Gerber N et al. Whole lung irradiation for adults with pulmonary metastases from Ewing’s sarcoma. Int. J. Radiat. Oncol. Biol. Phys. 89(5), 1069–1075 (2014).
    • 18. Ronchi L, Cammelli S, Ferrari S et al. EP-1340: whole lung irradiation in patients with Ewing’s sarcoma and pulmonary metastases at time of diagnosis. Radiother. Oncol. 115, S723, (2015).
    • 19. Scobioala S, Ranft A, Wolters et al. Impact of whole lung irradiation on survival outcome in patients with lung relapsed Ewing’s sarcoma. Int. J. Radiat. Oncol. Biol. Phys. 102(3), 584–592 (2018).
    • 20. Motosue M, Zhu L, Srivastava K et al. Pulmonary function after whole lung irradiation in pediatric patients with solid malignancies. Cancer 118(5), 1450–1456 (2011).
    • 21. Abid S, Malhotra V, Perry M. Radiation-induced and chemotherapy-induced pulmonary injury. Curr. Opin. Oncol. 13(4), 242–248 (2001).