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

Massimo E Abate; Silvia Cammelli; Letizia Ronchi; Barbara Diletto; Lorenza Gandola; Anna Paioli; Alessandra Longhi; Emanuela Palmerini; Nadia Puma; Angela Tamburini; Maurizio Mascarin; Elisa Coassin; Arcangelo Prete; Sebastian D Asaftei; Carla Manzitti; Gianni Bisogno; Marta Pierobon; Luca Coccoli; Mariella Capasso; Giovanni Grignani; Giuseppe M Milano; Valentina Kiren; Franca Fagioli; Stefano Ferrari; Piero Picci; Elisa Carretta; Roberto Luksch

doi:10.3390/cancers13112789

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

Massimo E Abate, Silvia Cammelli, Letizia Ronchi, Barbara Diletto, Lorenza Gandola, Anna Paioli, Alessandra Longhi, Emanuela Palmerini, Nadia Puma, Angela Tamburini, Maurizio Mascarin, Elisa Coassin, Arcangelo Prete, Sebastian D Asaftei, Carla Manzitti, Gianni Bisogno, Marta Pierobon, Luca Coccoli, Mariella Capasso, Giovanni GrignaniGiuseppe M Milano, Valentina Kiren, Franca Fagioli, Stefano Ferrari, Piero Picci, Elisa Carretta, Roberto Luksch

Istituti Ortopedici Rizzoli

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	1-12
Number of pages	12
Journal	Cancers
Volume	13
Issue number	11
DOIs	https://doi.org/10.3390/cancers13112789
Publication status	Published - Jun 3 2021

Keywords

Ewing sarcoma
busulfan
lung irradiation
melphalan
oncology
pulmonary metastasis

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10.3390/cancers13112789

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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., ... Luksch, R. (2021). 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. Cancers, 13(11), 1-12. https://doi.org/10.3390/cancers13112789

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. / Abate, Massimo E; Cammelli, Silvia; Ronchi, Letizia et al.

In: Cancers, Vol. 13, No. 11, 03.06.2021, p. 1-12.

Research output: Contribution to journal › Article › peer-review

Abate, ME, 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, SD, Manzitti, C, Bisogno, G, Pierobon, M, Coccoli, L, Capasso, M, Grignani, G, Milano, GM, Kiren, V, Fagioli, F, Ferrari, S, Picci, P, Carretta, E & Luksch, R 2021, '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', Cancers, vol. 13, no. 11, pp. 1-12. https://doi.org/10.3390/cancers13112789

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title = "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",

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.",

keywords = "Ewing sarcoma, busulfan, lung irradiation, melphalan, oncology, pulmonary metastasis",

author = "Abate, {Massimo E} and Silvia Cammelli and Letizia Ronchi and Barbara Diletto and Lorenza Gandola and Anna Paioli and Alessandra Longhi and Emanuela Palmerini and Nadia Puma and Angela Tamburini and Maurizio Mascarin and Elisa Coassin and Arcangelo Prete and Asaftei, {Sebastian D} and Carla Manzitti and Gianni Bisogno and Marta Pierobon and Luca Coccoli and Mariella Capasso and Giovanni Grignani and Milano, {Giuseppe M} and Valentina Kiren and Franca Fagioli and Stefano Ferrari and Piero Picci and Elisa Carretta and Roberto Luksch",

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T1 - 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

AU - Abate, Massimo E

AU - Cammelli, Silvia

AU - Ronchi, Letizia

AU - Diletto, Barbara

AU - Gandola, Lorenza

AU - Paioli, Anna

AU - Longhi, Alessandra

AU - Palmerini, Emanuela

AU - Puma, Nadia

AU - Tamburini, Angela

AU - Mascarin, Maurizio

AU - Coassin, Elisa

AU - Prete, Arcangelo

AU - Asaftei, Sebastian D

AU - Manzitti, Carla

AU - Bisogno, Gianni

AU - Pierobon, Marta

AU - Coccoli, Luca

AU - Capasso, Mariella

AU - Grignani, Giovanni

AU - Milano, Giuseppe M

AU - Kiren, Valentina

AU - Fagioli, Franca

AU - Ferrari, Stefano

AU - Picci, Piero

AU - Carretta, Elisa

AU - Luksch, Roberto

PY - 2021/6/3

Y1 - 2021/6/3

N2 - 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.

AB - 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.

KW - Ewing sarcoma

KW - busulfan

KW - lung irradiation

KW - melphalan

KW - oncology

KW - pulmonary metastasis

U2 - 10.3390/cancers13112789

DO - 10.3390/cancers13112789

M3 - Article

C2 - 34205124

SN - 2072-6694

VL - 13

SP - 1

EP - 12

JO - Cancers

JF - Cancers

IS - 11

ER -

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

Abstract

Keywords

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