Role of Whole Lung Irradiation in Ewings Sarcoma with Lung Metastases

1. ROLE OF WHOLE LUNG
IRRADIATION (WLI) IN A CASE
OF EWING’S SARCOMA WITH
PULMONARY METASTASES

2. • 23y / M, serving soldier
• A case of Ewing’s sarcoma Proximal Femur (Lt) (Optd)
• NACT Chemotherapy – 4# VAC/IE between 22/3/18 to 28/5/18
• Post surgery – WLE + Implant in Jul 2018
• Adjuvant Chemotherapy 13# VAC/IE from 22/3/18 till 6/5/19
• WB PET/CT – (11/6/19) – Mild FDG avid subpleural nodule RML with low grade uptake Rt femur
• NCCT chest - (14/6/19) – Random nodules in both lungs 8 x 5.5 mm
• NCCT chest – ( 11/11/19) – Increase in no. & size of pulm mets. Lytic lesion in LV1 – s/o bone met.
• WB PET/CT - (08/11/19) – Multiple Metabolically active B/L lung nodules (SUVm-12.06) &
metabolically active lesion in LV1 (SUVm -4.81)

6. • Retrospective
• 26 patients of ES with lung mets received WLI
• Dose was 12 to 15 Gy
• Technique was AP/PA for 19, IMRT for 7

7. No effect of
• age,
• type of RT,
• dose or
fractionation,
• Site/size of
primary,
• number of lung
mets,
• laterality of mets,
• response to
chemo,
• decade of
treatment

8. Cumulative incidence of Pulmonary Relapse
EFS
OS EFS by smoking status.

11. Summary
• No randomized studies exist
• Large cooperative group and single institute retrospective studies
(CESS & EICESS) have shown reduced pulmonary relapse, reduced
Event Free Survival and low rates of toxicity in pediatric population
• Results of retrospective studies in adults is similar
• Benefit of WLI appears independent of response of pulmonary lesions
to chemo
• Benefit seen primarily in patients with isolated pulmonary
metastases. Those with extrapulmonary mets as well fare poorly.