Adjuvant Radiotherapy for the Multimodal Treatment of Pediatric Ewing Sarcoma

Year 2022, Volume: 4 Issue: 3, 304 - 314, 22.09.2022

Gonca Altınışık İnan , İpek Pınar Aral , Tarık Kargıoğlu , Arzu Yazal Erdem , Selma Çakmakcı , Hüseyin Furkan Öztürk , Suheyla Aytaç Arslan , Yılmaz Tezcan

https://doi.org/10.37990/medr.1093314

Abstract

Aim: This study aimed to report the adjuvant radiotherapy results of pediatric patients with Ewing sarcoma who received multimodal treatment for this rare disease using modern radiotherapy (RT) techniques.
Material and Methods: Pediatric patients with Ewing Sarcoma (ES) who received adjuvant radiotherapy were evaluated retrospectively. The study’s primary endpoint was overall survival (OS) and disease-free survival (DFS). The secondary endpoint was local relapse-free survival after RT (LRFS- RT) and overall survival after RT (OS-RT).
Results: The results of 18 pediatric patients diagnosed with Ewing Sarcoma in our clinic between 09.12.2013-04.04.2021 and underwent RT for adjuvant were evaluated retrospectively. The three patients were excluded since they did not meet the inclusion criteria. The median age of the patients at the time of diagnosis was 10.5 (range 3-17). The time from diagnosis to the onset of RT was 8.6 (range 2-20) months. The median fraction dose was 180 cGy, and the median total RT dose was 50.4 (range 45-55.80) Gy. The median follow-up period of the study was 27 (range 11-86) months. The 12 (80%) patients survived, and 3 (20%) died. The median OS diagnosis of the patients was 27.3 (range 11 to 86.5) months. The overall survival of the patients after RT was median 17.3 (range 4.4-83.9) months. Recurrence (local+distant) was observed in 7 patients (46.7%); 2 (13.3%) local, 3 (20%) distant and 2 (13.3%) both. The median DFS was 24 months (range 1-86.5). Median LRFS-RT is 14.2 (range 1-83.9) months. The relationship between LRFS-RT and age (<10 vs. ≥10 years old) (p=0.050; HR:2.30; %95 CI 0.70-3.17) was significant. Significantly higher LRFS-RT was observed in the older age.
Conclusion: In patients with Ewing’s sarcoma who are at high risk of local failure after surgery, adjuvant radiotherapy could be applied to increase local control rate, with reasonable side effects.

Keywords

Adjuvant Radiotherapy, Ewing Sarcoma, Pediatric Oncology

Pediatrik Ewing Sarkoma Hastalarının Multimodal Tedavisinde Adjuvan Radyoterapi

Abstract

Amaç: Bu çalışmada Ewing sarkomu nedeniyle multimodal tedavi uygulanan çocuk hastaların adjuvan radyoterapi sonuçlarını bildirmeyi amaçladık.
Materyal Metot: Adjuvan radyoterapi (RT) alan Ewing Sarkomlu pediatrik hastalar geriye dönük olarak değerlendirildi. Çalışmanın birincil sonlanım noktası, Genel Sağkalım (GS) ve hastalıksız sağkalım (HS) idi. İkincil sonlanım noktaları, RT den sonra lokal nükssüz sağkalım (LRFS-RT) ve RT’den sonra genel sağkalım (GS-RT)’di.
Bulgular: Kliniğimizde 09.12.2013-04.04.2021 tarihleri arasında Ewing Sarkomu tanısıyla adjuvan RT uygulanan 18 çocuk hastanın sonuçları retrospektif olarak değerlendirildi. Üç hasta dahil edilme kriterlerini karşılamadıkları için çalışma dışı bırakıldı. Hastaların tanı anındaki ortanca yaşı 10.5 (dağılım 3-17) idi. Tanıdan RT başlangıcına kadar geçen süre 8.6 (2-20) aydı. Ortanca fraksiyon dozu 180 cGy ve ortanca toplam RT dozu 50.4 (aralık 45-55.80) Gy idi. Çalışmanın ortanca takip süresi 27 (dağılım 11-86) aydı. Oniki (%80) hasta sağ ve 3 (%20) hasta ölü idi. Hastaların ortanca GS değeri 27.3 (dağılım 11 ila 86,5) aydı. Hastaların RT sonrası GS ortanca 17.3 (aralık 4.4-83.9) aydı. Yedi hastada (%46.7) nüks (lokal+uzak) vardı; 2 (%13.3) lokal, 3 (%20) uzak ve 2 (%13.3) lokal+uzak met vardı. Ortanca HS 24 aydı (aralık 1-86.5). Ortanca LRFS-RT 14.2 (aralık 1-83.9) aydı. LRFS-RT ile yaş (<10 ve ≥yaş üstü) arasındaki ilişki (p=0.050; HR:2.30; %95 GA 0.70-3.17) anlamlıydı. İleri yaşta anlamlı olarak daha yüksek LRFS-RT gözlendi.
Sonuç: Ameliyat sonrası lokal başarısızlık riski yüksek olan Ewing sarkomlu hastalarda adjuvan radyoterapi ile lokal kontrol şansı arttırılmaya çalışılmaktadır.

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