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

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2021 Jul 2

PMID 34205124

Authors

Massimo E Abate

Silvia Cammelli

Letizia Ronchi

Barbara Diletto

Lorenza Gandola

Anna Paioli

Alessandra Longhi

Emanuela Palmerini

Nadia Puma

Angela Tamburini

Maurizio Mascarin

Elisa Coassin

Arcangelo Prete

Sebastian D Asaftei

Carla Manzitti

Gianni Bisogno

Marta Pierobon

Luca Coccoli

Mariella Capasso

Giovanni Grignani

Giuseppe M Milano

Valentina Kiren

Franca Fagioli

Stefano Ferrari

Piero Picci

Elisa Carretta

Roberto Luksch

Affiliations

Soon will be listed here.

Abstract

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.

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