Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Oct 11;2(4):174-9.
doi: 10.1016/j.jbo.2013.09.002. eCollection 2013 Dec.

Two Cases With Fatal Outcome Following Total Lung Irradiation for Metastatic Bone Sarcoma

Affiliations
Free PMC article

Two Cases With Fatal Outcome Following Total Lung Irradiation for Metastatic Bone Sarcoma

K Lia et al. J Bone Oncol. .
Free PMC article

Abstract

We report a single institution experience with total lung irradiation in 53 metastatic bone sarcoma patients in the context of two young female patients who died from treatment-induced pulmonary toxicity. A radiation dose of 19.5 Gy in 1.5 Gy daily fractions was given as two opposing fields with a conventional technique. Both patients succumbed within 3 months following radiotherapy. One patient had osteosarcoma whereas the other advanced Ewing's sarcoma; both with widespread metastases to the lungs at primary diagnosis. In retrospect, most likely high dose methotrexate lung toxicity observed in the osteosarcoma patient, and the GI-toxicity following pelvic radiotherapy in Ewing's case, both observed during the initial phase of their multimodal treatment, might indicate an increased individual radiosensitivity. In view of this, a review of our experience in 53 bone sarcoma patients (19 with Ewing's sarcoma and 34 with osteosarcoma) treated at our institution was conducted. We have not previously experienced significant toxicity following total lung irradiation. Among these, 42% (8/19) with Ewing's sarcoma and 9% (3/34) with osteosarcoma are long-term survivors and without clinically significant lung toxicity.

Keywords: Ewing's sarcoma; Lung toxicity; Osteosarcoma; Pulmonary irradiation; Pulmonary metastasis.

Figures

Fig. 1
Fig. 1
Chemotherapy given to patient 1 – modified EURAMOS-1 regime.
Fig. 2
Fig. 2
Chest CT of patient 1.
Fig. 3
Fig. 3
Chemotherapy given to patient 2 – modified according to ISG-SSG IV.
Fig. 4
Fig. 4
Treatment portals in patient 1.
Fig. 5
Fig. 5
Treatment portals in patient 2.
Fig. 6
Fig. 6
Bone sarcoma patients treated with total lung irradiation.

Similar articles

See all similar articles

References

    1. Whelan J.S., Burcombe R.J., Janinis J., Baldelli A.M., Cassoni A.M. A systematic review of the role of pulmonary irradiation in the management of primary bone tumours. Annals of Oncology. 2002;13(1):23–30. - PubMed
    1. Spunt S.L., McCarville M.B., Kun L.E., Poquette C.A., Cain A.M., Brandao L. Selective use of whole-lung irradiation for patients with Ewing sarcoma family tumors and pulmonary metastases at the time of diagnosis. Journal of Pediatric Hematology/Oncology. 2001;23(2):93–98. - PubMed
    1. Halperin E.C., Kun L.E., Constine L.S., Tarbell N.J. Raven Press; New York: 1989. Pediatric radiation oncology; pp. 215–219.
    1. Cassady J.R. Springer-Verlag; 1994. Radiation therapy in pediatric oncology; pp. 308–309.
    1. Caldwell W.L. Elective whole lung irradiation. Radiology. 1976;120(3):659–666. - PubMed
Feedback