Whole lung irradiation in patients with exclusively pulmonary metastases of Ewing tumors. Toxicity analysis and treatment results of the EICESS-92 trial.
BACKGROUND
In the European Intergroup Cooperative Ewing's Sarcoma Study (EICESS) 92, whole lung irradiation (WLI) was performed in patients with primary lung metastases. This retrospective analysis evaluates the pulmonary function and the outcome of patients with exclusively pulmonary metastases.


METHODS
Between 1990 and 1999, 99 patients were registered into the EICESS-92-study trial with exclusively pulmonary metastases of Ewing tumors. The multimodal treatment regimen included polychemotherapy and local therapy to the primary tumor. WLI was performed with a dose between 12-21 Gy. 70 patients were treated with WLI, 13 of them received a further boost to their primary tumor in the thorax up to a cumulative dose of 54 Gy.


RESULTS
Pulmonary function tests were available for 37 patients treated with WLI (+/- boost). None, mild, moderate or severe pulmonary complications were seen in 43%, 29%, 21% and 7% of patients treated with WLI without further boost (median follow-up 25.2 months). Patients with an additional radiation boost or surgery to the thorax showed slightly higher rates of complications. Overall survival (OAS) showed a trend towards better results for patients with WLI (5-year-OAS: 0.61 for WLI vs. 0.49 for no WLI, p = 0.36).


CONCLUSIONS
These data indicate a benefit and acceptable toxicity for WLI in the presented collective of patients. As long as there is no randomized prospective analysis, the present data confirm the indication for WLI in Ewing tumor patients with primary exclusively lung metastases.
Bölling
Tobias
T
Department of Radiotherapy, University Hospital Münster, Germany. Tobias.Boelling@ukmuenster.de
Schuck
Andreas
A
Paulussen
Michael
M
Dirksen
Uta
U
Ranft
Andreas
A
Könemann
Stefan
S
Dunst
Jürgen
J
Willich
Normann
N
Jürgens
Heribert
H
D000293:Adolescent; D000328:Adult; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000528:radiation effects*; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D009362:Neoplasm Metastasis / Q000532:radiotherapy; D010997:Pleural Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome