title: Radiation for bone metastases in Ewing sarcoma and rhabdomyosarcoma.
abstract: BACKGROUND
  The role, optimal dose, and efficacy of radiotherapy (RT) for the treatment of bone metastases in rhabdomyosarcoma (RMS) and Ewing sarcoma (ES) are unclear.
  
  
  METHODS
  All patients with ES or RMS who received RT for bone metastases with curative intent during frontline therapy at Memorial Sloan Kettering Cancer Center (MSKCC) between 1995 and 2013 were reviewed. Among the 30 patients (8 RMS and 22 ES), 49 bone metastases were irradiated.
  
  
  RESULTS
  Median biologically effective dose (BED) was 42.4 Gy (range, 34.9-59.7) for RMS and 50.7 Gy (range, 31.3-65.8) for ES. Tumor recurrence occurred in six of 49 irradiated bone metastases. Cumulative incidence of local failure at a treated metastatic site was 6.6% at 1 year and 9.0% at 3 years. Dose, fractionation, and RT technique did not impact local control at an irradiated site. The presence of >5 bone metastases was associated with worse local control at an irradiated site (P = 0.07). The 3-year EFS was 33% in RMS and 16% in ES.
  
  
  CONCLUSIONS
  RT appears to be an effective modality of local control for bone metastases in ES and RMS. Local control at sites of metastatic bone irradiation is similar to local control at the primary site after definitive RT. Doses in the biologic range prescribed for the definitive treatment of primary disease should be used for metastatic sites of disease.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Dana L
authors.initials: DL
authors.lastname: Casey
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Wexler
authors.forename: Paul A
authors.initials: PA
authors.lastname: Meyers
authors.forename: Heather
authors.initials: H
authors.lastname: Magnan
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Chou
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Wolden
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D012512:Sarcoma, Ewing / Q000453:epidemiology / Q000473:pathology / Q000628:therapy
keywords: Ewing sarcoma; radiation oncology; rhabdomyosarcoma