Abate Massimo E, Cammelli Silvia, Ronchi Letizia, Diletto Barbara, Gandola Lorenza, Paioli Anna, Longhi Alessandra, Palmerini Emanuela, Puma Nadia, Tamburini Angela, Mascarin Maurizio, Coassin Elisa, Prete Arcangelo, Asaftei Sebastian D, Manzitti Carla, Bisogno Gianni, Pierobon Marta, Coccoli Luca, Capasso Mariella, Grignani Giovanni, Milano Giuseppe M, Kiren Valentina, Fagioli Franca, Ferrari Stefano, Picci Piero, Carretta Elisa, Luksch Roberto
Paediatric Oncology, AORN Santobono-Pausilipon, 80123 Napoli, Italy.
Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Cancers (Basel). 2021 Jun 3;13(11):2789. doi: 10.3390/cancers13112789.
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).
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.
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.
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.
分析接受白消安和马法兰（BU-MEL）治疗后行全肺照射（WLI）的尤因肉瘤肺转移患者的毒性反应及预后预测因素。
这项回顾性研究纳入了68例尤因肉瘤肺转移患者，他们作为两个前瞻性连续治疗方案的一部分，在接受BU-MEL和自体干细胞移植后接受了WLI。14岁以下患者给予WLI 12 Gy，14岁及以上患者给予15 Gy，在BU-MEL后至少8周进行。评估并分析毒性反应、总生存期（OS）、无事件生存期（EFS）和无肺复发生存期（PRFS）。
WLI后，分别有16.2%和5.9%的患者报告了1-2级和3级临床毒性反应。5年OS、EFS和PRFS及其95%置信区间（CI）分别为69.8%（57.1-79.3）、61.2%（48.4-71.7）和70.5%（56.3-80.8）。与组织学坏死较差的患者相比，新辅助化疗后原发肿瘤组织学坏死良好的患者肺复发或死亡风险显著降低。
在BU-MEL后按推荐剂量和时间间隔进行WLI是可行的，可能有助于控制尤因肉瘤肺转移和反应性疾病。需要进一步研究以探索基于原发肿瘤组织学反应的治疗分层。
