Why the study?
To evaluate the efficiency and safety of Bu-Mel-based high-dose chemotherapy and whole lung irradiation as a salvage sequence in Ewing sarcoma lung relapses.
Does a salvage sequence of conventional chemotherapy, Bu-Mel-HDCT, and WLI improve survival in pediatric Ewing sarcoma patients with pulmonary relapse?
Does a salvage sequence of conventional chemotherapy, Bu-Mel-HDCT, and WLI improve survival in pediatric Ewing sarcoma patients with pulmonary relapse?
The aggressive salvage strategy of Bu-Mel HDCT followed by WLI provides favorable long-term survival in selected pediatric Ewing sarcoma patients with lung relapse, though with significant risk of lung toxicity.
Answers are grounded in this paper and cite their sources.
May offer viable salvage option for selected pediatric Ewing lung relapses; leaves open prospective validation in larger cohorts.
OBJECTIVE: Regarding the efficiency of Bu-Mel-based high-dose-chemotherapy (Bu-Mel-HDCT) and whole lung irradiation (WLI), the objective was to evaluate the efficiency and safety of this salvage sequence in Ewing sarcoma (ES) lung relapses. METHODS: All eligible pediatric ES patients (1991-2020) identified in SFCE departments were retrospectively reviewed. Seven patients were (1) diagnosed with a pulmonary relapse, isolated or not, (2) naïve from both HCDT and WLI (3) treated by the salvage sequence of conventional chemotherapy, Bu-Mel-HDCT and WLI. The main endpoint was OS evaluation. WLI toxicities were scored using CTC-V5. RESULTS: With a 13 years median follow-up (FU), 5/7 patients are alive and in complete remission. 10y-EFS is 71.4%. Three patients experienced transitory radio-induced pneumopathy (RIP). A patient developed RIP (gr.3) and finally progressive lung fibrosis leading to death. CONCLUSION: This study reports seven ES patients treated for lung metastatic relapses, using an aggressive strategy, with favorable survival long-term results which should be balanced with the risk of lung toxicity. ADVANCES IN KNOWLEDGE: The approach of surgery, Bu-Mel HDCT followed by WLI can be discussed in selected ES patients with lung relapse, naive from HDCT or WLI, providing an optimal chemosensitivity. A special vigilance is necessary regarding the incidence rate of lung toxicity which can be mitigated by limiting the radiotherapy dose, and observing optimal timing of radiotherapy after HDCT.
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Duvergé et al. (2022) studied this question.
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