1. Whole Lung Irradiation after High-Dose Busulfan/Melphalan in Ewing Sarcoma with Lung Metastases: An Italian Sarcoma Group and Associazione Italiana Ematologia Oncologia Pediatrica Joint Study
- Author
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Massimo Eraldo Abate, Lorenza Gandola, Barbara Diletto, Elisa Coassin, Giovanni Grignani, Carla Manzitti, Valentina Kiren, Arcangelo Prete, Stefano Ferrari, Giuseppe Milano, Nadia Puma, Silvia Cammelli, Alessandra Longhi, Luca Coccoli, Angela Tamburini, Letizia Ronchi, Emanuela Palmerini, Franca Fagioli, Mariella Capasso, Elisa Carretta, Maurizio Mascarin, Anna Paioli, Sebastian Dorin Asaftei, Roberto Luksch, Piero Picci, Marta Pierobon, Gianni Bisogno, Abate M.E., Cammelli S., Ronchi L., Diletto B., Gandola L., Paioli A., Longhi A., Palmerini E., Puma N., Tamburini A., Mascarin M., Coassin E., Prete A., Asaftei S.D., Manzitti C., Bisogno G., Pierobon M., Coccoli L., Capasso M., Grignani G., Milano G.M., Kiren V., Fagioli F., Ferrari S., Picci P., Carretta E., and Luksch R.
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0301 basic medicine ,Oncology ,Melphalan ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Article ,03 medical and health sciences ,0302 clinical medicine ,Autologous stem-cell transplantation ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Busulfan ,Ewing sarcoma ,Lung irradiation ,Pulmonary metastasis ,busulfan ,neoplasms ,pulmonary metastasis ,RC254-282 ,Chemotherapy ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Retrospective cohort study ,medicine.disease ,Primary tumor ,melphalan ,030104 developmental biology ,Metastatic Ewing Sarcoma ,030220 oncology & carcinogenesis ,lung irradiation ,oncology ,Sarcoma ,business ,medicine.drug - Abstract
Purpose: 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). Methods: 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. Results: 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. Conclusions: 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.
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- 2021