Impact of Whole Lung Irradiation on Survival Outcome in Patients With Lung Relapsed Ewing Sarcoma

Scobioala, Sergiu; Ranft, Andreas; Wolters, Heidi; Jabar, Susanne; Paulussen, Michael; Timmermann, Beate; Juergens, Heribert; Hassenpflug, Wolf; Klingebiel, Thomas; Elsayad, Khaled; Eich, Hans Theodor; Dirksen, Uta

doi:10.1016/j.ijrobp.2018.06.032

Cited by 17 publications

(21 citation statements)

References 33 publications

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“…1, Table 1). One study was a randomized controlled single-arm trial [14], while all other studies were retrospective analyses [1,5,[15][16][17][18][19][20]. Most of the retrospective series were considered to have a low risk of selection bias.…”

Section: Literature Searchmentioning

confidence: 99%

“…Most of the retrospective series were considered to have a low risk of selection bias. The earliest article was published by Miser et al in 1988 and the latest by Scobioala et al in 2018 [5,18]. The studies were reported both by radiation oncology and pediatrics departments ( Table 1).…”

Section: Literature Searchmentioning

confidence: 99%

“…In two studies, HD-Cth was given as consolidation treatment after maintenance Cth and before WLI [5,14]. Lucksch et al used HD-Cth with busulfan/melphalan (Bu/Mel) in 57 patients with primary pulmonary or single bone metastases with an interval of 60-90 days before WLI [14].…”

Section: Treatment Modalitiesmentioning

confidence: 99%

“…Despite a lack of prospective trials, present data show whole lung irradiation (WLI) to be an important part of curative therapy for pediatric and young adult patients with pulmonary manifestations of Ewing sarcoma (EwS) [1][2][3][4][5]. Most importantly, the use of WLI in these patients resulted in a marginal trend towards better survival [1][2][3][4][5]. According to the multicenter cooperative EwS studies (CESS), WLI should complement multimodal therapy in pediatric EwS patients with complete radiological remission of pulmonary metastases following polychemotherapy or after the resection of residual pulmonary metastases [6].…”

Section: Introductionmentioning

confidence: 99%

“…However, tolerance of WLI combined with high-dose Cth (HD-Cth) has not been sufficiently analyzed in published multicentre studies researching therapy and survival in EwS patients with pulmonary metastases [1,2,5,9]. This systematic review evaluates the risk stratification of pulmonary function disorders, as well as radiogenic acute and late lung toxicities in the combined use of HD-Cth and WLI in primary and relapsed EwS patients exhibiting lung metastases.…”

Section: Introductionmentioning

confidence: 99%

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Risk stratification of pulmonary toxicities in the combination of whole lung irradiation and high-dose chemotherapy for Ewing sarcoma patients with lung metastases: a review

Scobioala

Eich

2020

Strahlenther Onkol

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Background Whole lung irradiation (WLI) represents an important part of multimodal therapy in Ewing sarcoma (EwS) patients diagnosed with pulmonary metastases. This review discusses pulmonary toxicity in EwS patients with pulmonary metastases treated with WLI, who received different modes of high-dose chemotheray (HD-Cth). Methods Literature was compiled using the Cochrane Library, PubMed database, and the National Institute of Health (NIH) clinical trials register. Relevant patient information, including nature of HD-Cth, acute and late lung toxicities, and pulmonary function disorders, was selected from the above databases. Results Nine reports with a total of 227 patients, including 57 patients from a single randomized trial were included in this review. No acute or chronic symptomatic pulmonary toxicities were observed in patients that received WLI after HD busulfan-melphalan (HD-Bu/Mel), but 8% of these patients were diagnosed with asymptomatic restrictive lung disease. Grade 1 or 2 acute or chronic lung adverse effects were observed in up to 30% of patients that received WLI after HD treosulfan/Mel (HD-Treo/Mel) or HD etoposide (E)/Mel. Interstitial pneumonitis was present in 9% of patients treated concurrently with E/Mel and total body irradiation (TBI) with 8 Gy. Radiation doses as well as time between HD-Cth and WLI were both identified as significant risk factors for pulmonary function disorders. Conclusion The risk of adverse lung effects after WLI depends on several factors, including cumulative radiation dose and dose per fraction, HD-Cth regimen, and time interval between HD-Cth and WLI. A cumulative radiation dose of up to 15 Gy and a time interval of at least 60 days can potentially lead to a reduced risk of pulmonary toxicities. No evident adverse lung effects were registered in patients that received simultaneous therapy with HD-Cth and TBI. However, pulmonary function testing and lung toxicity reports were lacking for most of these patients.

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