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Risk stratification of pulmonary toxicities in the combination of whole lung irradiation and high-dose chemotherapy for Ewing sarcoma patients with lung metastases: a review.
Strahlenther Onkol. 2020 Jun; 196(6):495-504.SO

Abstract

BACKGROUND

Whole lung irradiation (WLI) represents an important part of multimodal therapy in Ewing sarcoma (EwS) patients diagnosed with pulmonary metastases. This review discusses pulmonary toxicity in EwS patients with pulmonary metastases treated with WLI, who received different modes of high-dose chemotheray (HD-Cth).

METHODS

Literature was compiled using the Cochrane Library, PubMed database, and the National Institute of Health (NIH) clinical trials register. Relevant patient information, including nature of HD-Cth, acute and late lung toxicities, and pulmonary function disorders, was selected from the above databases.

RESULTS

Nine reports with a total of 227 patients, including 57 patients from a single randomized trial were included in this review. No acute or chronic symptomatic pulmonary toxicities were observed in patients that received WLI after HD busulfan-melphalan (HD-Bu/Mel), but 8% of these patients were diagnosed with asymptomatic restrictive lung disease. Grade 1 or 2 acute or chronic lung adverse effects were observed in up to 30% of patients that received WLI after HD treosulfan/Mel (HD-Treo/Mel) or HD etoposide (E)/Mel. Interstitial pneumonitis was present in 9% of patients treated concurrently with E/Mel and total body irradiation (TBI) with 8 Gy. Radiation doses as well as time between HD-Cth and WLI were both identified as significant risk factors for pulmonary function disorders.

CONCLUSION

The risk of adverse lung effects after WLI depends on several factors, including cumulative radiation dose and dose per fraction, HD-Cth regimen, and time interval between HD-Cth and WLI. A cumulative radiation dose of up to 15 Gy and a time interval of at least 60 days can potentially lead to a reduced risk of pulmonary toxicities. No evident adverse lung effects were registered in patients that received simultaneous therapy with HD-Cth and TBI. However, pulmonary function testing and lung toxicity reports were lacking for most of these patients.

Authors+Show Affiliations

Department of Radiotherapy and Radiooncology, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany. sscobioala@yahoo.com.Department of Radiotherapy and Radiooncology, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32166453

Citation

Scobioala, Sergiu, and Hans Theodor Eich. "Risk Stratification of Pulmonary Toxicities in the Combination of Whole Lung Irradiation and High-dose Chemotherapy for Ewing Sarcoma Patients With Lung Metastases: a Review." Strahlentherapie Und Onkologie : Organ Der Deutschen Rontgengesellschaft ... [et Al], vol. 196, no. 6, 2020, pp. 495-504.
Scobioala S, Eich HT. Risk stratification of pulmonary toxicities in the combination of whole lung irradiation and high-dose chemotherapy for Ewing sarcoma patients with lung metastases: a review. Strahlenther Onkol. 2020;196(6):495-504.
Scobioala, S., & Eich, H. T. (2020). Risk stratification of pulmonary toxicities in the combination of whole lung irradiation and high-dose chemotherapy for Ewing sarcoma patients with lung metastases: a review. Strahlentherapie Und Onkologie : Organ Der Deutschen Rontgengesellschaft ... [et Al], 196(6), 495-504. https://doi.org/10.1007/s00066-020-01599-8
Scobioala S, Eich HT. Risk Stratification of Pulmonary Toxicities in the Combination of Whole Lung Irradiation and High-dose Chemotherapy for Ewing Sarcoma Patients With Lung Metastases: a Review. Strahlenther Onkol. 2020;196(6):495-504. PubMed PMID: 32166453.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk stratification of pulmonary toxicities in the combination of whole lung irradiation and high-dose chemotherapy for Ewing sarcoma patients with lung metastases: a review. AU - Scobioala,Sergiu, AU - Eich,Hans Theodor, Y1 - 2020/03/12/ PY - 2019/08/20/received PY - 2020/02/25/accepted PY - 2020/3/14/pubmed PY - 2020/3/14/medline PY - 2020/3/14/entrez KW - Chemotherapy KW - Ewing sarcoma KW - Lung metastases KW - Lung side effects KW - Radiotherapy SP - 495 EP - 504 JF - Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] JO - Strahlenther Onkol VL - 196 IS - 6 N2 - BACKGROUND: Whole lung irradiation (WLI) represents an important part of multimodal therapy in Ewing sarcoma (EwS) patients diagnosed with pulmonary metastases. This review discusses pulmonary toxicity in EwS patients with pulmonary metastases treated with WLI, who received different modes of high-dose chemotheray (HD-Cth). METHODS: Literature was compiled using the Cochrane Library, PubMed database, and the National Institute of Health (NIH) clinical trials register. Relevant patient information, including nature of HD-Cth, acute and late lung toxicities, and pulmonary function disorders, was selected from the above databases. RESULTS: Nine reports with a total of 227 patients, including 57 patients from a single randomized trial were included in this review. No acute or chronic symptomatic pulmonary toxicities were observed in patients that received WLI after HD busulfan-melphalan (HD-Bu/Mel), but 8% of these patients were diagnosed with asymptomatic restrictive lung disease. Grade 1 or 2 acute or chronic lung adverse effects were observed in up to 30% of patients that received WLI after HD treosulfan/Mel (HD-Treo/Mel) or HD etoposide (E)/Mel. Interstitial pneumonitis was present in 9% of patients treated concurrently with E/Mel and total body irradiation (TBI) with 8 Gy. Radiation doses as well as time between HD-Cth and WLI were both identified as significant risk factors for pulmonary function disorders. CONCLUSION: The risk of adverse lung effects after WLI depends on several factors, including cumulative radiation dose and dose per fraction, HD-Cth regimen, and time interval between HD-Cth and WLI. A cumulative radiation dose of up to 15 Gy and a time interval of at least 60 days can potentially lead to a reduced risk of pulmonary toxicities. No evident adverse lung effects were registered in patients that received simultaneous therapy with HD-Cth and TBI. However, pulmonary function testing and lung toxicity reports were lacking for most of these patients. SN - 1439-099X UR - https://www.unboundmedicine.com/medline/citation/32166453/Risk_stratification_of_pulmonary_toxicities_in_the_combination_of_whole_lung_irradiation_and_high-dose_chemotherapy_for_Ewing_sarcoma_patients_with_lung_metastases:_a_review L2 - https://dx.doi.org/10.1007/s00066-020-01599-8 DB - PRIME DP - Unbound Medicine ER -
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