Spunt S L, McCarville M B, Kun L E, Poquette C A, Cain A M, Brandao L, Pappo A S
Department of Hematology/Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
J Pediatr Hematol Oncol. 2001 Feb;23(2):93-8. doi: 10.1097/00043426-200102000-00005.
The benefit of whole-lung irradiation (WLI) for patients who have pulmonary metastases (PM) of Ewing sarcoma family tumors (ESFT) is unclear. At our institution, WLI is reserved for patients with PM that do not respond completely to induction chemotherapy. We reviewed our experience to assess the impact of WLI on clinical outcome.
Twenty-eight patients with ESFT and PM were treated in three consecutive institutional trials (1979-1996). Extent of pulmonary involvement at diagnosis, response of PM after induction chemotherapy, local treatment of PM thereafter, and clinical outcome were recorded. Treatment included primary tumor surgery and/or radiotherapy and 42 to 58 weeks of multiagent chemotherapy.
Only eight patients (29%) received WLI. For the entire study group, the estimated 5-year event-free survival was 22.9% +/- 9.0%; the 5-year survival was 37.3% +/- 9.8%. Complete resolution of PM after induction chemotherapy was not correlated with survival (P = 0.53), nor was treatment with WLI (P = 0.87).
The comparable survival of patients with poor and good response of PM to induction chemotherapy suggests that WLI may benefit poor responders. The use of WLI in good responders may provide similar benefit and merits further study.
全肺照射（WLI）对尤因肉瘤家族性肿瘤（ESFT）肺转移（PM）患者的益处尚不清楚。在我们机构，WLI仅用于对诱导化疗未完全反应的PM患者。我们回顾了我们的经验，以评估WLI对临床结局的影响。
28例ESFT和PM患者在三项连续的机构试验（1979 - 1996年）中接受治疗。记录诊断时肺部受累程度、诱导化疗后PM的反应、此后PM的局部治疗以及临床结局。治疗包括原发肿瘤手术和/或放疗以及42至58周的多药化疗。
仅8例患者（29%）接受了WLI。对于整个研究组，估计的5年无事件生存率为22.9%±9.0%；5年生存率为37.3%±9.8%。诱导化疗后PM的完全缓解与生存率无关（P = 0.53），WLI治疗也无关（P = 0.87）。
PM对诱导化疗反应差和反应好的患者生存率相当，这表明WLI可能使反应差的患者受益。对反应好的患者使用WLI可能提供类似益处，值得进一步研究。
