Selective use of whole-lung irradiation for patients with Ewing sarcoma family tumors and pulmonary metastases at the time of diagnosis

Purpose: The benefit of whole-lung irradiation (WLI) for patients who have pulmonary metastases (PM) of Ewing sarcoma family tumors (ESFT) is unclear. Ar our institution, WLI is reserved for patients with PM that do not respo nd completely to induction chemotherapy. We reviewed our experience to asse ss the impact of WLI on clinical outcome. Patients and Methods: Twenty-eight patients with ESFT and PM were treated i n three consecutive institutional trials (1979-1996). Extent of pulmonary i nvolvement at diagnosis, response of Ph I after induction chemotherapy, loc al treatment of PM thereafter, and clinical outcome were recorded. Treatmen t included primary tumor surgery and/or radiotherapy and 42 to 58 weeks of multiagent chemotherapy. Results: Only eight patients (29%) received WLI. For the entire study group , the estimated 5-year event-free survival was 22.9% +/- 9.0%; the 5-year s urvival was 37.3% +/- 9.8%. Complete resolution of PM after induction chemo therapy was not correlated with survival (P = 0.53), nor was treatment with WLI (P = 0.87). Conclusions: The comparable survival of patients with poor and good respons e of PM to induction chemotherapy suggests that WLI may benefit poor respon ders. The use of WLI in good responders may provide similar benefit and mer its further study.