scholarly journals Whole Lung Irradiation after High-Dose Busulfan/Melphalan in Ewing Sarcoma with Lung Metastases: An Italian Sarcoma Group and Associazione Italiana Ematologia Oncologia Pediatrica Joint Study

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2789
Author(s):  
Massimo E. Abate ◽  
Silvia Cammelli ◽  
Letizia Ronchi ◽  
Barbara Diletto ◽  
Lorenza Gandola ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Primary Tumor ◽  
Lung Metastases ◽  
High Dose ◽  
Time Interval ◽  
Treatment Protocols ◽  
Old Patients ◽  
Free Survival ◽  
Lung Irradiation ◽  
Whole Lung Irradiation

Purpose: To analyze toxicity and outcome predictors in Ewing sarcoma patients with lung metastases treated with busulfan and melphalan (BU-MEL) followed by whole-lung irradiation (WLI). Methods: This retrospective study included 68 lung metastatic Ewing Sarcoma patients who underwent WLI after BU-MEL with autologous stem cell transplantation, as part of two prospective and consecutive treatment protocols. WLI 12 Gy for <14 years old and 15 Gy for ≥14 years old patients were applied at least eight weeks after BU-MEL. Toxicity, overall survival (OS), event-free survival (EFS) and pulmonary relapse-free survival (PRFS) were estimated and analyzed. Results: After WLI, grade 1–2 and grade 3 clinical toxicity was reported in 16.2% and 5.9% patients, respectively. The five-year OS, EFS and PRFS with 95% confidence interval (CI) were 69.8% (57.1–79.3), 61.2% (48.4–71.7) and 70.5% (56.3–80.8), respectively. Patients with good histological necrosis of the primary tumor after neoadjuvant chemotherapy showed a significant decreased risk of pulmonary relapse or death compared to patients with poor histological necrosis. Conclusions: WLI at recommended doses and time interval after BU-MEL is feasible and might contribute to the disease control in Ewing sarcoma with lung metastases and responsive disease. Further studies are needed to explore the treatment stratification based on the histological response of the primary tumor.

scholarly journals Treatment of Lung Metastases from Ewing Sarcoma with Stereotactic Body Radiotherapy rather than Whole-Lung Irradiation

2012 ◽  
Vol 46 (1) ◽  
pp. 34-36
Author(s):  
Douglas A Rahn ◽  
William Read ◽  
Ajay Sandhu
Keyword(s):  
Ewing Sarcoma ◽  
Stereotactic Body Radiotherapy ◽  
Lung Metastases ◽  
Primary Lung Cancer ◽  
Normal Lung ◽  
Term Survival ◽  
Lung Irradiation ◽  
Summary Statement ◽  
Whole Lung Irradiation

ABSTRACT Advances in knowledge Lung metastases from Ewing sarcoma have traditionally been treated with whole-lung irradiation (WLI) and chemotherapy. WLI may unnecessarily treat uninvolved normal lung tissue and increase the risk of toxicity. Stereotactic body radiotherapy (SBRT) has proven to be a safe and effective treatment for primary lung cancer and lung metastases, but there is no significant published description of SBRT in lung metastases from Ewing sarcoma. Implications for patient care The patient presented in this case report had long-term survival from lung metastases of Ewing sarcoma treated with chemotherapy and SBRT. SBRT may prove to be safer and more effective than whole lung irradiation as a treatment of lung metastases in Ewing sarcoma. Summary statement Whether SBRT of lung metastases of Ewing sarcoma can improve outcomes and decrease toxicity compared to whole-lung irradiation, surgical resection or palliative chemotherapy merits further study. How to cite this article Rahn DA, Read W, Sandhu A. Treatment of Lung Metastases from Ewing Sarcoma with Stereotactic Body Radiotherapy rather than Whole-Lung Irradiation. J Postgrad Med Edu Res 2012;46(1):34-36.

Ewing's tumors with primary lung metastases: survival analysis of 114 (European Intergroup) Cooperative Ewing's Sarcoma Studies patients.

1998 ◽  
Vol 16 (9) ◽  
pp. 3044-3052 ◽  
Author(s):  
M Paulussen ◽  
S Ahrens ◽  
A W Craft ◽  
J Dunst ◽  
B Fröhlich ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Primary Tumor ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Lung Metastases ◽  
Local Treatment ◽  
Poor Response ◽  
Chemotherapy Response ◽  
Treatment Intensification ◽  
Lung Irradiation

PURPOSE To analyze event-free survival (EFS) and prognostic factors in patients who present with Ewing's tumors (ET) of bone and synchronous pulmonary and/or pleural metastases (ppm). PATIENTS AND METHODS Of 1,270 patients (pts) registered at the continental office of the German/European Intergroup Cooperative Ewing's Sarcoma Studies (CESS81, CESS86, EICESS92), 114 were diagnosed ET with ppm. Patients underwent neoadjuvant therapy and local treatment of the primary tumor. Whole-lung irradiation 15 to 18 Gy was applied to 75 ppm-pts. EFS and 95% confidence intervals (CIs) were estimated according to the Kaplan-Meier method, and prognostic factors were analyzed by log-rank tests and Cox and logistic regression procedures. RESULTS On November 1, 1997, at a median time under study of 5.9 years, the 5-year EFS was 0.36 (95% CI, 0.26 to 0.46) and the 10-year EFS was 0.30 (95% CI, 0.19 to 0.41). Thirty-seven of 59 (63%) first relapses involved lung and/or pleura, and the lungs were the only site of relapse in 26 of 59 (44%) ppm-pts. Risk factors identified in univariate and multivariate tests were poor response of the primary tumor toward chemotherapy, metastatic lesions in both lungs, and treatment without additional lung irradiation. CONCLUSION Chemotherapy response of the primary tumor is a prognostic factor in patients with ET with ppm. Strategies of treatment intensification warrant further evaluation.

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

2020 ◽  
Vol 16 (15) ◽  
pp. 1043-1051
Author(s):  
Hagar Elghazawy ◽  
Azza Nasr ◽  
Iman Zaky ◽  
Manal Zamzam ◽  
Ahmed Elgammal ◽  
...  
Keyword(s):  
Pulmonary Metastases ◽  
Pediatric Population ◽  
Event Free Survival ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Real Value ◽  
Lung Irradiation ◽  
Whole Lung Irradiation ◽  
The Impact

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.

Weekly high-dose methotrexate and doxorubicin for osteosarcoma: the Dana-Farber Cancer Institute/the Children's Hospital--study III.

1987 ◽  
Vol 5 (8) ◽  
pp. 1178-1184 ◽  
Author(s):  
A M Goorin ◽  
A Perez-Atayde ◽  
M Gebhardt ◽  
J W Andersen ◽  
R H Wilkinson ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Lymphocytic Infiltration ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Dana Farber Cancer Institute ◽  
Dose Methotrexate ◽  
Leucovorin Rescue ◽  
Hospital Study

Weekly high-dose methotrexate with leucovorin rescue and vincristine (HDMTX) and doxorubicin was administered as adjuvant postoperative therapy to 46 patients with a diagnosis of conventional high-grade nonmetastatic osteosarcoma of an extremity between July 1976 and December 1981. The primary lesions were managed by wide or radical amputation (26 patients) or by limb-sparing resection in 20 selected patients. The margins of the resections were retrospectively classified as marginal in three, wide in 16, and radical in one. The 5-year relapse-free survival (RFS) for all patients is 59% (95% confidence interval [CI], 43%, 74%) and overall survival is 78% (95% CI, 65%, 91%). The RFS for patients initially having a limb resection procedure is 55% (95% CI, 32%, 77%) compared with 62% (95% CI, 43%, 81%) for those initially having amputations (P = .52). Using multivariate analysis, the only significant prognostic variables that predicted RFS of greater than or equal to 3 years, were the presence of moderate to marked lymphocytic infiltration of the primary tumor (P less than .002), primary site outside of the proximal humerus (P less than .005), and the absence of a predominance of osteoblastic pattern in the primary tumor (P less than .03).

scholarly journals Randomized Controlled Trial of Interval-Compressed Chemotherapy for the Treatment of Localized Ewing Sarcoma: A Report From the Children's Oncology Group

2012 ◽  
Vol 30 (33) ◽  
pp. 4148-4154 ◽  
Author(s):  
Richard B. Womer ◽  
Daniel C. West ◽  
Mark D. Krailo ◽  
Paul S. Dickman ◽  
Bruce R. Pawel ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Ewing Sarcoma ◽  
Primary Tumor ◽  
Controlled Trial ◽  
Tumor Treatment ◽  
Free Survival ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Treatment Surgery ◽  
Median Interval

Purpose Chemotherapy with alternating vincristine-doxorubicin-cyclophosphamide and ifosfamide-etoposide cycles and primary tumor treatment with surgery and/or radiation therapy constitute the usual approach to localized Ewing sarcoma in North America. We tested whether chemotherapy intensification through interval compression could improve outcome. Patients and Methods This was a prospective, randomized controlled trial for patients younger than 50 years old with newly diagnosed localized extradural Ewing sarcoma. Patients assigned to standard and intensified treatment were to begin chemotherapy cycles every 21 and 14 days, respectively, provided an absolute neutrophil count greater than 750 × 106/L and a platelet count greater than 75 × 109/L. Patients received vincristine (2 mg/m2), doxorubicin (75 mg/m2), and cyclophosphamide (1.2 g/m2) alternating with ifosfamide (9 g/m2) and etoposide (500 mg/m2) for 14 cycles, with filgrastim (5 mg/kg per day; maximum, 300 mg) between cycles. Primary tumor treatment (surgery, radiation, or both) was to begin at week 13 (after four cycles in the standard arm and six cycles in the intensified arm). The primary end point was event-free survival (EFS). The study is registered at ClinicalTrials.gov (identifier: NCT00006734). Results Five hundred eighty-seven patients were enrolled and randomly assigned, and 568 patients were eligible, with 284 patients in each regimen. For all cycles, the median cycle interval for standard treatment was 21 days (mean, 22.45 days); for intensified treatment, the median interval was 15 days (mean, 17.29 days). EFS at a median of 5 years was 65% in the standard arm and 73% in the intensified arm (P = .048). The toxicity of the regimens was similar. Conclusion For localized Ewing sarcoma, chemotherapy administered every 2 weeks is more effective than chemotherapy administered every 3 weeks, with no increase in toxicity.

Whole Lung Irradiation in Patients With Relapsed Ewing Sarcoma

2017 ◽  
Vol 99 (2) ◽  
pp. E571
Author(s):  
S. Scobioala ◽  
U. Dirksen ◽  
H. Juergens ◽  
H.T.T. Eich
Keyword(s):  
Ewing Sarcoma ◽  
Lung Irradiation ◽  
Whole Lung Irradiation

Standard-dose and high-dose peptichemio and cisplatin in children with disseminated poor-risk neuroblastoma: two studies by the Italian Cooperative Group for Neuroblastoma.

1992 ◽  
Vol 10 (12) ◽  
pp. 1870-1878 ◽  
Author(s):  
B De Bernardi ◽  
M Carli ◽  
F Casale ◽  
P Corciulo ◽  
L Cordero di Montezemolo ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Tumor Regression ◽  
Standard Dose ◽  
Autologous Bone Marrow Transplantation ◽  
Progression Free Survival ◽  
High Dose ◽  
Cooperative Group ◽  
Complete Excision ◽  
Treatment Protocols ◽  
Poor Risk

PURPOSE The objective of the present study was to determine whether an increase in the intensity of therapy improves outcome for children with disseminated poor-risk neuroblastoma. PATIENTS AND METHODS From January 1982 through November 1989, 181 children 1 year or older with newly diagnosed disseminated neuroblastoma were entered onto two consecutive studies of the Italian Cooperative Group for Neuroblastoma (ICGNB): 75 (study NB82) were enrolled from 1982 to 1984 and were treated with standard-dose (SD) chemotherapy, and 106 (study NB85) were enrolled from 1985 to 1989 and received high-dose (HD) chemotherapy. In both treatment protocols, induction therapy included peptichemio and cisplatin (at SD or HD, respectively) and removal of the primary tumor. In study NB82, children who achieved complete or partial tumor regression received SD consolidation therapy, and in study NB85 they received three cycles of HD chemotherapy (3cCT) or one cycle of myeloablative therapy (MAT) followed by autologous bone marrow transplantation (ABMT). RESULTS Compared with group NB82, the NB85 group had significantly fewer failures (no tumor response or disease progression) after administration of peptichemio (9% v 31%; P < .01), had more complete responses (CRs) and partial responses (PRs) both after treatment with cisplatin (60% v 43%; P = .01) and after surgery (76% v 57%; P < .01), and was more likely to have achieved complete excision of the primary tumor (70% v 46%; P < .01). Overall survival (OS) and progression-free survival (PFS) at 5 years were 11% and 9% in NB82, and 27% and 18% in NB85 (P < .01 for both); however, in NB85, relapses occurred even after 5 years of CR, so that PFS curves converge approximately 7 years after diagnosis. Median survival time was 14 months in NB82 and 24 months in NB85. Children in the NB85 group who after achievement of CR were consolidated with 3cCT had a 5-year PFS of 24% compared with 32% of those treated with MAT followed by ABMT (P = .5). CONCLUSION Intensified therapy improves response rate and prolongs survival of children with disseminated neuroblastoma, although its impact on the eventual cure rate remains to be established.

scholarly journals Whole Lung Irradiation in Patients with Osteosarcoma and Ewing Sarcoma

2018 ◽  
Vol 38 (9) ◽  
pp. 4977-4985 ◽  
Author(s):  
LETIZIA RONCHI ◽  
MILLY BUWENGE ◽  
ANNALISA CORTESI ◽  
ILARIO AMMENDOLIA ◽  
REZARTA FRAKULLI ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Lung Irradiation ◽  
Whole Lung Irradiation
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