Radiation for Pulmonary Relapse in Ewing Sarcoma: A Scoping Review

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.