Dana L Casey1, Kaled M Alektiar1, Naamit K Gerber1, Suzanne L Wolden2. 1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. 2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: woldens@mskcc.org.
Abstract
PURPOSE: To evaluate feasibility and patterns of failure in adult patients with Ewing sarcoma (ES) treated with whole lung irradiation (WLI) for pulmonary metastases. METHODS AND MATERIALS: Retrospective review of all ES patients treated at age 18 or older with 12-15 Gy WLI for pulmonary metastases at a single institution between 1990 and 2014. Twenty-six patients met the study criteria. RESULTS: The median age at WLI was 23 years (range, 18-40). The median follow-up time of the surviving patients was 3.8 years (range, 1.0-9.6). The 3-year cumulative incidence of pulmonary relapse (PR) was 55%, with a 3-year cumulative incidence of PR as the site of first relapse of 42%. The 3-year event-free survival (EFS) and overall survival (OS) were 38 and 45%, respectively. Patients with exclusively pulmonary metastases had better outcomes than did those with extrapulmonary metastases: the 3-year PR was 45% in those with exclusively lung metastases versus 76% in those with extrapulmonary metastases (P=.01); the 3-year EFS was 49% versus 14% (P=.003); and the 3-year OS was 61% versus 13% (P=.009). Smoking status was a significant prognostic factor for EFS: the 3-year EFS was 61% in nonsmokers versus 11% in smokers (P=.04). Two patients experienced herpes zoster in the radiation field 6 and 12 weeks after radiation. No patients experienced pneumonitis or cardiac toxicity, and no significant acute or late sequelae were observed among the survivors. CONCLUSION: WLI in adult patients with ES and lung metastases is well tolerated and is associated with freedom from PR of 45% at 3 years. Given its acceptable toxicity and potential therapeutic effect, WLI for pulmonary metastases in ES should be considered for adults, as it is in pediatric patients. All patients should be advised to quit smoking before receiving WLI.
PURPOSE: To evaluate feasibility and patterns of failure in adult patients with Ewing sarcoma (ES) treated with whole lung irradiation (WLI) for pulmonary metastases. METHODS AND MATERIALS: Retrospective review of all ESpatients treated at age 18 or older with 12-15 Gy WLI for pulmonary metastases at a single institution between 1990 and 2014. Twenty-six patients met the study criteria. RESULTS: The median age at WLI was 23 years (range, 18-40). The median follow-up time of the surviving patients was 3.8 years (range, 1.0-9.6). The 3-year cumulative incidence of pulmonary relapse (PR) was 55%, with a 3-year cumulative incidence of PR as the site of first relapse of 42%. The 3-year event-free survival (EFS) and overall survival (OS) were 38 and 45%, respectively. Patients with exclusively pulmonary metastases had better outcomes than did those with extrapulmonary metastases: the 3-year PR was 45% in those with exclusively lung metastases versus 76% in those with extrapulmonary metastases (P=.01); the 3-year EFS was 49% versus 14% (P=.003); and the 3-year OS was 61% versus 13% (P=.009). Smoking status was a significant prognostic factor for EFS: the 3-year EFS was 61% in nonsmokers versus 11% in smokers (P=.04). Two patients experienced herpes zoster in the radiation field 6 and 12 weeks after radiation. No patients experienced pneumonitis or cardiac toxicity, and no significant acute or late sequelae were observed among the survivors. CONCLUSION: WLI in adult patients with ES and lung metastases is well tolerated and is associated with freedom from PR of 45% at 3 years. Given its acceptable toxicity and potential therapeutic effect, WLI for pulmonary metastases in ES should be considered for adults, as it is in pediatric patients. All patients should be advised to quit smoking before receiving WLI.
Authors: Uta Dirksen; Bernadette Brennan; Marie-Cécile Le Deley; Nathalie Cozic; Henk van den Berg; Vivek Bhadri; Bénédicte Brichard; Line Claude; Alan Craft; Susanne Amler; Natalie Gaspar; Hans Gelderblom; Robert Goldsby; Richard Gorlick; Holcombe E Grier; Jean-Marc Guinbretiere; Peter Hauser; Lars Hjorth; Katherine Janeway; Heribert Juergens; Ian Judson; Mark Krailo; Jarmila Kruseova; Thomas Kuehne; Ruth Ladenstein; Cyril Lervat; Stephen L Lessnick; Ian Lewis; Claude Linassier; Perrine Marec-Berard; Neyssa Marina; Bruce Morland; Hélène Pacquement; Michael Paulussen; R Lor Randall; Andreas Ranft; Gwénaël Le Teuff; Keith Wheatley; Jeremy Whelan; Richard Womer; Odile Oberlin; Douglas S Hawkins Journal: J Clin Oncol Date: 2019-09-25 Impact factor: 50.717