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Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer

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Radiation for Pulmonary Relapse in Ewing Sarcoma: A Scoping Review.

Jessica E Briggs¹, Rachel Offenbacher¹, Alissa Baker¹

¹Division of Pediatric Hematology, Oncology, and Cellular Therapy, The Children's Hospital at Montefiore.

Journal of Pediatric Hematology/Oncology

|December 30, 2025

Summary

Whole lung irradiation (WLI) may improve progression-free survival in relapsed Ewing sarcoma (EWS) lung metastases, especially after resection. Stereotactic body radiation therapy (SBRT) targets active disease. Future studies should explore combining SBRT with low-dose WLI.

Keywords:

Ewing sarcoma pulmonary radiation relapse

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Area of Science:

Oncology
Radiation Oncology
Pediatric Oncology

Background:

Ewing sarcoma (EWS) is a rare but aggressive bone and soft tissue cancer.
Relapsed EWS has poor prognosis, with isolated lung relapse occurring in approximately one-third of patients.
Current management for isolated pulmonary EWS relapse lacks a standardized approach.

Purpose of the Study:

To review existing literature on pulmonary-directed radiation for isolated lung relapse of Ewing sarcoma.
To compare the efficacy and toxicity of whole lung irradiation (WLI) and stereotactic body radiation therapy (SBRT).
To provide guidance for managing pulmonary relapsed EWS.

Main Methods:

A systematic literature review was conducted using PubMed and Web of Science.
Studies included patients with pulmonary relapsed or metastatic EWS treated with radiation therapy.
Twelve articles were selected for analysis, focusing on WLI (8 studies) and SBRT (4 studies).

Main Results:

Patients receiving WLI demonstrated improved progression-free survival compared to those treated with SBRT.
Both WLI and SBRT exhibited low rates of reported toxicity.
WLI showed benefit in patients who underwent complete resection prior to radiation, while SBRT was effective for active disease sites.

Conclusions:

Whole lung irradiation may be beneficial for isolated pulmonary EWS relapse, particularly post-resection.
Stereotactic body radiation therapy is a viable option for targeting specific areas of active disease.
Future research should investigate combining SBRT with low-dose WLI to potentially reduce future metastatic risk.