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Pencil beam scanned protons for the treatment of patients with Ewing sarcoma
Author(s) -
Weber Damien C.,
Murray Fritz R.,
Correia Dora,
Bolsi Alessandra,
FreiWelte Martina,
Pica Alessia,
Lomax Antony J.,
Schneider Ralf,
Bachtiary Barbara
Publication year - 2017
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26688
Subject(s) - medicine , sarcoma , pencil beam scanning , overall survival , distant metastasis , metastasis , nuclear medicine , radiation therapy , proton therapy , oncology , radiology , pathology , cancer
Background Few data exist regarding the clinical outcome of patients with Ewing sarcoma (EWS) treated with pencil beam scanning proton therapy (PT). We report the outcome of children, adolescents and young adults (AYA) treated with PT at the Paul Scherrer Institute. Materials Thirty‐eight patients (median age, 9.9 years) received a median dose of 54.9 Gy(RBE) (where RBE is relative biologic effectiveness). Size of the tumor ranged from 1.7 to 24 cm. Most common primary site was axial/pelvic (n = 27; 71%). Four patients (11%) presented with metastases at diagnosis. Twenty (53%) patients had chemo‐PT only. Median follow‐up was 49.6 months (range, 9.2–131.7). Results The 5‐year actuarial rate of local control (LC), distant metastasis‐free survival (DMFS), and overall survival (OS) were 81.5%, 76.4%, and 83.0%, respectively. All local recurrences occurred in field and in patients with nonextremity primaries. Six patients died, all of tumor progression. Age < 10 years was a favorable factor of borderline significance for LC ( P = 0.05) and OS ( P = 0.05), but was significant for DMFS ( P = 0.003). Tumor volume <200 ml was a significant prognostic factors for DMFS ( P = 0.03), but not for OS ( P = 0.07). Metastasis at diagnosis was a strong predictor of local failure ( P = 0.003). Only two grade 3 late toxicities were observed. The 5‐year actuarial rate of grade 3 toxicity‐free survival was 90.9%. Conclusions These preliminary data suggest that the outcomes of children and AYA with EWS are good and PT was well tolerated with few late adverse events. The local and distant tumor control for older patients with large pre‐PT tumor volumes remains problematic.