Lung irradiation for Ewing's sarcoma with pulmonary metastases at diagnosis: results of the CESS-studies.
BACKGROUND
In the German CESS-studies, Ewing's sarcoma patients with pulmonary metastases at diagnosis were considered as candidates for additional bilateral lung irradiation. We have retrospectively analyzed the impact of radiotherapy on survival.


METHODS
Out of 42 patients presenting with pulmonary metastases of Ewing's sarcoma between 1981 and June 1992, 30 were evaluable. One patient died of progressive disease prior to lung irradiation. The other patients had a complete radiographic remission either after chemotherapy (n = 25) or chemotherapy plus resection of lung metastases (n = 4). 22 patients received bilateral lung irradiation with doses of 12 to 21 Gy (once daily 1.5 Gy or twice daily 1.25 Gy), six had no further treatment and one had bone marrow transplantation for consolidation.


RESULTS
Ten patients are in complete remission, nine of them had received lung irradiation and one had a complete resection of three lung metastases. Two patients are alive with disease, two have died from treatment-related complications and 16 have died from systemic disease with or without local relapse. NED-patients had received significant higher lung doses than relapsed patients p = 0.028. Moreover, a dose-response relationship was detectable: 1/6 patients without lung irradiation vs. 4/10 with 12 to 16 Gy vs. 5/6 with 18 to 21 Gy lung irradiation were in remission.


CONCLUSIONS
In this retrospective analysis, lung irradiation was beneficial in terms of improved survival of patients with pulmonary metastases of Ewing's sarcoma. We actually recommend lung irradiation with 18 (to 20) Gy for pulmonary metastases of Ewing's sarcoma.
Dunst
J
J
Department of Radiotherapy, University of Erlangen, Germany.
Paulussen
M
M
Jürgens
H
H
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005858:Germany; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D011879:Radiotherapy Dosage; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D014750:Vincristine / Q000008:administration & dosage
D003609:Dactinomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D007069:Ifosfamide