Researchers from Germany have reported promising results of intensive chemotherapy combined with radiotherapy directed at MRI-detected bone disease in patients with Ewing’s Sarcoma. The details of this study were published in the March 2010 issue of Bone Marrow Transplantation.[1]

The Ewing’s sarcoma family of tumors are sensitive to chemotherapy, but cure is difficult to achieve once relapse occurs. The role of high-dose chemotherapy for Ewing’s sarcoma has been controversial but is utilized by most groups treating children and young adults. A recent report from the Fred Hutchinson Cancer Research Center showed that 46% of chemotherapy-responsive patients became long-term survivors compared with 0% of those who were resistant to re-induction chemotherapy. They also reported that tandem transplants were more effective than single transplants with survivals of 75% and 20%, respectively. In this study patients who receive total body irradiation in the transplant regimen also had better outcomes.

In the current study, total body irradiation was not used. Instead, 11 patients with metastatic Ewing’s sarcoma received radiation only to sites of bone identified as positive on total body MRI scans. Six of the 11 patients had additional lung disease. Patients in this study received induction chemotherapy, and all sites identified by MRI were irradiated. This was followed by autologous stem cell rescue. A control group consisted of 26 patients who were similar but did not receive MRI-guided radiotherapy. Survival in the MRI-guided irradiation group was 45% compared with 8% in the control group at five years.

Comments: These data are in accord with data on total body irradiation regimens previously reported. These observations need to be validated in a randomized controlled study.

Reference:

[1] Burdach S, Thiel U, Schoniger M, et al. Total body MRI-governed involved compartment irradiation combined with high-dose chemotherapy and stem cell rescue improves long-term survival in Ewing tumor patients with multiple primary bone metastases. Bone Marrow Transplantation. 2010;45:483-489.