Role of Metastatic Site Irradiation in Pediatric Patients With Metastatic Ewing Sarcoma
| Autor: | Sharonjit K Grewal, Christine E. Hill-Kayser, Amardeep S. Grewal, G. Kurtz, Richard B. Womer, Yimei Li, Zelig Tochner, Naomi Balamuth, Rochelle Bagatell |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Lung Neoplasms Adolescent medicine.medical_treatment Bone Neoplasms Soft Tissue Neoplasms Sarcoma Ewing Young Adult 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Medicine In patient Child Retrospective Studies Chemotherapy Lung Radiotherapy business.industry Hematology Prognosis Survival Rate Log-rank test Radiation therapy Increased risk medicine.anatomical_structure Metastatic Ewing Sarcoma Child Preschool 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health Cohort Female business Follow-Up Studies 030215 immunology |
| Zdroj: | Journal of Pediatric Hematology/Oncology. 42:e305-e309 |
| ISSN: | 1077-4114 |
| DOI: | 10.1097/mph.0000000000001752 |
| Popis: | Background The use of radiation therapy to treat metastases in patients with metastatic Ewing sarcoma (MES) has been controversial and variable. The authors report outcomes and patterns of failure after metastatic site irradiation (MSI). Procedure A total of 27 pediatric patients with MES were treated with chemotherapy and received radiation therapy to their primary site. Ten patients additionally received MSI, which consisted of whole-lung irradiation (WLI) in patients with lung metastases. Metastatic sites were followed from diagnosis to the first relapse. Results Median follow-up was 29 months. Seventy-eight percent of patients relapsed. Two-year progression-free survival (PFS) and overall survival with and without MSI were 30 versus 29% (log rank P=0.38) and 60 versus 70% (log rank P=0.11), respectively. The median time to relapse among patients who relapsed was 19.5 versus 12.3 months for those receiving MSI versus those who did not (P=0.04).Seven of 20 (35%) patients with lung metastases received WLI±other MSI. Two-year PFS with and without MSI was 43% versus 23% (log rank P=0.02). Among patients with a complete response to computed tomography, 5 of 14 (36%) patients received MSI. Two-year PFS with and without MSI was 60% versus 33% (log rank P=0.04).In the cohort of patients who relapsed, among all metastatic sites at diagnosis, the disease recurred at 15% of irradiated sites and 31% of unirradiated sites. On logistic regression, no factors were statistically associated with increased risk of recurrence at initial sites of metastases. Conclusions Relapses frequently occur at sites of prior unirradiated disease in patients with MES. WLI may improve 2-year PFS, regardless of chemotherapy response. Further investigation of the role of MSI is warranted. |
| Databáze: | OpenAIRE |
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