title: Two cases with fatal outcome following total lung irradiation for metastatic bone sarcoma.
abstract: We report a single institution experience with total lung irradiation in 53 metastatic bone sarcoma patients in the context of two young female patients who died from treatment-induced pulmonary toxicity. A radiation dose of 19.5 Gy in 1.5 Gy daily fractions was given as two opposing fields with a conventional technique. Both patients succumbed within 3 months following radiotherapy. One patient had osteosarcoma whereas the other advanced Ewing's sarcoma; both with widespread metastases to the lungs at primary diagnosis. In retrospect, most likely high dose methotrexate lung toxicity observed in the osteosarcoma patient, and the GI-toxicity following pelvic radiotherapy in Ewing's case, both observed during the initial phase of their multimodal treatment, might indicate an increased individual radiosensitivity. In view of this, a review of our experience in 53 bone sarcoma patients (19 with Ewing's sarcoma and 34 with osteosarcoma) treated at our institution was conducted. We have not previously experienced significant toxicity following total lung irradiation. Among these, 42% (8/19) with Ewing's sarcoma and 9% (3/34) with osteosarcoma are long-term survivors and without clinically significant lung toxicity.
authors.affiliation: Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, P.O. Box 4953, Nydalen, 0424 Oslo, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Lia
authors.affiliation: Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, P.O. Box 4953, Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, 0310 Oslo, Norway.
authors.forename: Ø S
authors.initials: ØS
authors.lastname: Bruland
authors.affiliation: Department of Medical Physics, Norwegian Radium Hospital, Oslo University Hospital, P.O. Box 4953, Nydalen, 0424 Oslo, Norway.
authors.forename: H L
authors.initials: HL
authors.lastname: Randem
authors.affiliation: Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, P.O. Box 4953, Nydalen, 0424 Oslo, Norway.
authors.forename: L H
authors.initials: LH
authors.lastname: Aksnes
authors.affiliation: Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, P.O. Box 4953, Nydalen, 0424 Oslo, Norway.
authors.forename: J P
authors.initials: JP
authors.lastname: Poulsen
authors.affiliation: Department of Radiology, Norwegian Radium Hospital, Oslo University Hospital, P.O. Box 4953, Nydalen, 0424 Oslo, Norway.
authors.forename: I
authors.initials: I
authors.lastname: Taksdal
authors.affiliation: Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, P.O. Box 4953, Nydalen, 0424 Oslo, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Sundby Hall
keywords: Ewing's sarcoma; Lung toxicity; Osteosarcoma; Pulmonary irradiation; Pulmonary metastasis