Whole Lung Irradiation in Patients with Osteosarcoma and Ewing Sarcoma

Letizia Ronchi, Milly Buwenge, Annalisa Cortesi, Ilario Ammendolia, Rezarta Frakulli, Massimo E Abate, Alessandra Arcelli, Costanza M Donati, Gabriella Macchia, Alessio G Morganti, Silvia Cammelli

Research output: Contribution to journalReview article

Abstract

BACKGROUND/AIM: Whole lung irradiation (WLI) represents standard therapy for patients with pulmonary metastases from Ewing sarcoma although the impact on clinical outcomes and toxicity is still unclear. The aim of this study was to evaluate toxicity after WLI in patients with Ewing sarcoma and osteosarcoma as well as overall survival (OS) and event-free survival (EFS).

MATERIALS AND METHODS: A systematic review of studies on bilateral pulmonary irradiation treatments for prophylactic or curative therapy was performed based on PRISMA methodology. Data base searches on PubMed and Cochrane Library from the earliest time possible through 31st March 2018 were carried out. Combination with other treatments, such as chemotherapy and surgery were allowed. Only articles published in English were considered.

RESULTS: Toxicity was evaluated in 13 of the 14 analyzed studies (640 patients). Reported lung acute toxicity grade ≥3 ranged between 0.0 and 12.2%. Three studies reported 12 cases (1.8%) of severe pneumonitis. Grade ≥2 late toxicity was mainly recorded in patients who received boost irradiation, previous thoracic surgery, chemotherapy or who were smokers. Lack of a significant impact of WLI on OS was reported in comparative studies although patients treated with WLI showed higher survival in most individual studies.

CONCLUSION: Although the rate of severe toxicity was very low, the real impact of WLI on patients' outcomes remains unproven, probably due to the narrow dose limits that can be delivered to the whole lung parenchyma. New strategies to prevent or treat lung metastases in these patients should be tested. Ultra-fractionated radiotherapy concurrent with modern chemotherapy protocols could be tested in this setting due to the chemo-sensitizing effect and negligible radio-induced toxicity of fraction doses <0.5 Gy.

Original languageEnglish
Pages (from-to)4977-4985
Number of pages9
JournalAnticancer Research
Volume38
Issue number9
DOIs
Publication statusPublished - Sep 2018

Fingerprint

Ewing's Sarcoma
Osteosarcoma
Lung
Drug Therapy
Survival
Neoplasm Metastasis
Therapeutics
Radio
PubMed
Thoracic Surgery
Libraries
Disease-Free Survival
Pneumonia
Radiotherapy
Databases

Keywords

  • Bone Neoplasms/radiotherapy
  • Clinical Trials as Topic
  • Disease-Free Survival
  • Female
  • Humans
  • Lung Neoplasms/radiotherapy
  • Male
  • Osteosarcoma/radiotherapy
  • Radiotherapy/adverse effects
  • Sarcoma, Ewing/radiotherapy
  • Treatment Outcome
  • Young Adult

Cite this

Ronchi, L., Buwenge, M., Cortesi, A., Ammendolia, I., Frakulli, R., Abate, M. E., ... Cammelli, S. (2018). Whole Lung Irradiation in Patients with Osteosarcoma and Ewing Sarcoma. Anticancer Research, 38(9), 4977-4985. https://doi.org/10.21873/anticanres.12816

Whole Lung Irradiation in Patients with Osteosarcoma and Ewing Sarcoma. / Ronchi, Letizia; Buwenge, Milly; Cortesi, Annalisa; Ammendolia, Ilario; Frakulli, Rezarta; Abate, Massimo E; Arcelli, Alessandra; Donati, Costanza M; Macchia, Gabriella; Morganti, Alessio G; Cammelli, Silvia.

In: Anticancer Research, Vol. 38, No. 9, 09.2018, p. 4977-4985.

Research output: Contribution to journalReview article

Ronchi, L, Buwenge, M, Cortesi, A, Ammendolia, I, Frakulli, R, Abate, ME, Arcelli, A, Donati, CM, Macchia, G, Morganti, AG & Cammelli, S 2018, 'Whole Lung Irradiation in Patients with Osteosarcoma and Ewing Sarcoma', Anticancer Research, vol. 38, no. 9, pp. 4977-4985. https://doi.org/10.21873/anticanres.12816
Ronchi L, Buwenge M, Cortesi A, Ammendolia I, Frakulli R, Abate ME et al. Whole Lung Irradiation in Patients with Osteosarcoma and Ewing Sarcoma. Anticancer Research. 2018 Sep;38(9):4977-4985. https://doi.org/10.21873/anticanres.12816
Ronchi, Letizia ; Buwenge, Milly ; Cortesi, Annalisa ; Ammendolia, Ilario ; Frakulli, Rezarta ; Abate, Massimo E ; Arcelli, Alessandra ; Donati, Costanza M ; Macchia, Gabriella ; Morganti, Alessio G ; Cammelli, Silvia. / Whole Lung Irradiation in Patients with Osteosarcoma and Ewing Sarcoma. In: Anticancer Research. 2018 ; Vol. 38, No. 9. pp. 4977-4985.
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abstract = "BACKGROUND/AIM: Whole lung irradiation (WLI) represents standard therapy for patients with pulmonary metastases from Ewing sarcoma although the impact on clinical outcomes and toxicity is still unclear. The aim of this study was to evaluate toxicity after WLI in patients with Ewing sarcoma and osteosarcoma as well as overall survival (OS) and event-free survival (EFS).MATERIALS AND METHODS: A systematic review of studies on bilateral pulmonary irradiation treatments for prophylactic or curative therapy was performed based on PRISMA methodology. Data base searches on PubMed and Cochrane Library from the earliest time possible through 31st March 2018 were carried out. Combination with other treatments, such as chemotherapy and surgery were allowed. Only articles published in English were considered.RESULTS: Toxicity was evaluated in 13 of the 14 analyzed studies (640 patients). Reported lung acute toxicity grade ≥3 ranged between 0.0 and 12.2{\%}. Three studies reported 12 cases (1.8{\%}) of severe pneumonitis. Grade ≥2 late toxicity was mainly recorded in patients who received boost irradiation, previous thoracic surgery, chemotherapy or who were smokers. Lack of a significant impact of WLI on OS was reported in comparative studies although patients treated with WLI showed higher survival in most individual studies.CONCLUSION: Although the rate of severe toxicity was very low, the real impact of WLI on patients' outcomes remains unproven, probably due to the narrow dose limits that can be delivered to the whole lung parenchyma. New strategies to prevent or treat lung metastases in these patients should be tested. Ultra-fractionated radiotherapy concurrent with modern chemotherapy protocols could be tested in this setting due to the chemo-sensitizing effect and negligible radio-induced toxicity of fraction doses <0.5 Gy.",
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note = "Copyright{\circledC} 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.",
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T1 - Whole Lung Irradiation in Patients with Osteosarcoma and Ewing Sarcoma

AU - Ronchi, Letizia

AU - Buwenge, Milly

AU - Cortesi, Annalisa

AU - Ammendolia, Ilario

AU - Frakulli, Rezarta

AU - Abate, Massimo E

AU - Arcelli, Alessandra

AU - Donati, Costanza M

AU - Macchia, Gabriella

AU - Morganti, Alessio G

AU - Cammelli, Silvia

N1 - Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

PY - 2018/9

Y1 - 2018/9

N2 - BACKGROUND/AIM: Whole lung irradiation (WLI) represents standard therapy for patients with pulmonary metastases from Ewing sarcoma although the impact on clinical outcomes and toxicity is still unclear. The aim of this study was to evaluate toxicity after WLI in patients with Ewing sarcoma and osteosarcoma as well as overall survival (OS) and event-free survival (EFS).MATERIALS AND METHODS: A systematic review of studies on bilateral pulmonary irradiation treatments for prophylactic or curative therapy was performed based on PRISMA methodology. Data base searches on PubMed and Cochrane Library from the earliest time possible through 31st March 2018 were carried out. Combination with other treatments, such as chemotherapy and surgery were allowed. Only articles published in English were considered.RESULTS: Toxicity was evaluated in 13 of the 14 analyzed studies (640 patients). Reported lung acute toxicity grade ≥3 ranged between 0.0 and 12.2%. Three studies reported 12 cases (1.8%) of severe pneumonitis. Grade ≥2 late toxicity was mainly recorded in patients who received boost irradiation, previous thoracic surgery, chemotherapy or who were smokers. Lack of a significant impact of WLI on OS was reported in comparative studies although patients treated with WLI showed higher survival in most individual studies.CONCLUSION: Although the rate of severe toxicity was very low, the real impact of WLI on patients' outcomes remains unproven, probably due to the narrow dose limits that can be delivered to the whole lung parenchyma. New strategies to prevent or treat lung metastases in these patients should be tested. Ultra-fractionated radiotherapy concurrent with modern chemotherapy protocols could be tested in this setting due to the chemo-sensitizing effect and negligible radio-induced toxicity of fraction doses <0.5 Gy.

AB - BACKGROUND/AIM: Whole lung irradiation (WLI) represents standard therapy for patients with pulmonary metastases from Ewing sarcoma although the impact on clinical outcomes and toxicity is still unclear. The aim of this study was to evaluate toxicity after WLI in patients with Ewing sarcoma and osteosarcoma as well as overall survival (OS) and event-free survival (EFS).MATERIALS AND METHODS: A systematic review of studies on bilateral pulmonary irradiation treatments for prophylactic or curative therapy was performed based on PRISMA methodology. Data base searches on PubMed and Cochrane Library from the earliest time possible through 31st March 2018 were carried out. Combination with other treatments, such as chemotherapy and surgery were allowed. Only articles published in English were considered.RESULTS: Toxicity was evaluated in 13 of the 14 analyzed studies (640 patients). Reported lung acute toxicity grade ≥3 ranged between 0.0 and 12.2%. Three studies reported 12 cases (1.8%) of severe pneumonitis. Grade ≥2 late toxicity was mainly recorded in patients who received boost irradiation, previous thoracic surgery, chemotherapy or who were smokers. Lack of a significant impact of WLI on OS was reported in comparative studies although patients treated with WLI showed higher survival in most individual studies.CONCLUSION: Although the rate of severe toxicity was very low, the real impact of WLI on patients' outcomes remains unproven, probably due to the narrow dose limits that can be delivered to the whole lung parenchyma. New strategies to prevent or treat lung metastases in these patients should be tested. Ultra-fractionated radiotherapy concurrent with modern chemotherapy protocols could be tested in this setting due to the chemo-sensitizing effect and negligible radio-induced toxicity of fraction doses <0.5 Gy.

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KW - Female

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KW - Lung Neoplasms/radiotherapy

KW - Male

KW - Osteosarcoma/radiotherapy

KW - Radiotherapy/adverse effects

KW - Sarcoma, Ewing/radiotherapy

KW - Treatment Outcome

KW - Young Adult

U2 - 10.21873/anticanres.12816

DO - 10.21873/anticanres.12816

M3 - Review article

C2 - 30194141

VL - 38

SP - 4977

EP - 4985

JO - Anticancer Research

JF - Anticancer Research

SN - 0250-7005

IS - 9

ER -