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Clinical impact of post-induction resolution of pulmonary lesions in metastatic Ewing sarcoma.
Pediatr Blood Cancer 2020; :e28150PB

Abstract

BACKGROUND

Patients with metastatic Ewing sarcoma experience poor outcomes despite intensive systemic and local therapy. Early chemotherapy response of pulmonary metastases has been associated with prognosis in other pediatric malignancies. We reviewed the outcomes of patients with Ewing sarcoma and pulmonary metastases treated at our institution based on therapy received and early pulmonary response.

MATERIALS AND METHODS

We retrospectively reviewed patients with newly diagnosed Ewing sarcoma and pulmonary metastases at St. Jude Children's Research Hospital between 1979 and 2015. Data obtained included demographic and treatment characteristics including chemotherapy, local control measures, whole lung irradiation (WLI) administration, autologous stem cell transplantation, and outcomes. Patients were evaluated for radiographic post-induction pulmonary complete response (CR). We estimated event-free survival (EFS) and overall survival (OS) and used Cox proportional hazards regression to examine the effects of clinical and treatment factors on outcomes.

RESULTS

Fifty-four patients (median age, 12.9 years) were evaluated. Post-induction pulmonary CR was observed in 33 (61%) patients. WLI was delivered to 16 patients (4/33 with pulmonary CR and 12/21 with non-CR). At median 3.6 years follow-up, five-year EFS and OS were 30.8% ± 6.4% and 49.6% ± 7.1%, respectively. Post-induction pulmonary CR was associated with prolonged EFS (P < 0.001) but not improved OS (P = 0.065). Post-induction pulmonary CR was associated with a lower incidence of lung failure (P = 0.031).

CONCLUSIONS

Post-induction pulmonary CR is associated with improved EFS in patients with Ewing sarcoma who present with pulmonary metastases.

Authors+Show Affiliations

Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee. Department of Radiology, University of Tennessee Health Sciences Center, Memphis, Tennessee.Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31944574

Citation

Halalsheh, Hadeel, et al. "Clinical Impact of Post-induction Resolution of Pulmonary Lesions in Metastatic Ewing Sarcoma." Pediatric Blood & Cancer, 2020, pp. e28150.
Halalsheh H, Kaste SC, Krasin MJ, et al. Clinical impact of post-induction resolution of pulmonary lesions in metastatic Ewing sarcoma. Pediatr Blood Cancer. 2020.
Halalsheh, H., Kaste, S. C., Krasin, M. J., Sykes, A., Sahr, N., Spunt, S. L., ... Bishop, M. W. (2020). Clinical impact of post-induction resolution of pulmonary lesions in metastatic Ewing sarcoma. Pediatric Blood & Cancer, pp. e28150. doi:10.1002/pbc.28150.
Halalsheh H, et al. Clinical Impact of Post-induction Resolution of Pulmonary Lesions in Metastatic Ewing Sarcoma. Pediatr Blood Cancer. 2020 Jan 15;e28150. PubMed PMID: 31944574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical impact of post-induction resolution of pulmonary lesions in metastatic Ewing sarcoma. AU - Halalsheh,Hadeel, AU - Kaste,Sue C, AU - Krasin,Matthew J, AU - Sykes,April, AU - Sahr,Natasha, AU - Spunt,Sheri L, AU - Federico,Sara M, AU - Bishop,Michael W, Y1 - 2020/01/15/ PY - 2019/10/25/received PY - 2019/12/03/revised PY - 2019/12/12/accepted PY - 2020/1/17/entrez KW - Ewing sarcoma KW - early response KW - event-free survival KW - pulmonary metastases SP - e28150 EP - e28150 JF - Pediatric blood & cancer JO - Pediatr Blood Cancer N2 - BACKGROUND: Patients with metastatic Ewing sarcoma experience poor outcomes despite intensive systemic and local therapy. Early chemotherapy response of pulmonary metastases has been associated with prognosis in other pediatric malignancies. We reviewed the outcomes of patients with Ewing sarcoma and pulmonary metastases treated at our institution based on therapy received and early pulmonary response. MATERIALS AND METHODS: We retrospectively reviewed patients with newly diagnosed Ewing sarcoma and pulmonary metastases at St. Jude Children's Research Hospital between 1979 and 2015. Data obtained included demographic and treatment characteristics including chemotherapy, local control measures, whole lung irradiation (WLI) administration, autologous stem cell transplantation, and outcomes. Patients were evaluated for radiographic post-induction pulmonary complete response (CR). We estimated event-free survival (EFS) and overall survival (OS) and used Cox proportional hazards regression to examine the effects of clinical and treatment factors on outcomes. RESULTS: Fifty-four patients (median age, 12.9 years) were evaluated. Post-induction pulmonary CR was observed in 33 (61%) patients. WLI was delivered to 16 patients (4/33 with pulmonary CR and 12/21 with non-CR). At median 3.6 years follow-up, five-year EFS and OS were 30.8% ± 6.4% and 49.6% ± 7.1%, respectively. Post-induction pulmonary CR was associated with prolonged EFS (P < 0.001) but not improved OS (P = 0.065). Post-induction pulmonary CR was associated with a lower incidence of lung failure (P = 0.031). CONCLUSIONS: Post-induction pulmonary CR is associated with improved EFS in patients with Ewing sarcoma who present with pulmonary metastases. SN - 1545-5017 UR - https://www.unboundmedicine.com/medline/citation/31944574/Clinical_impact_of_post-induction_resolution_of_pulmonary_lesions_in_metastatic_Ewing_sarcoma L2 - https://doi.org/10.1002/pbc.28150 DB - PRIME DP - Unbound Medicine ER -