ArticleFrontiers in oncology2026
Case report: Helical tomotherapy-based whole lung irradiation with simultaneous integrated boost for pulmonary metastatic Ewing's sarcoma: a case series report and feasibility analysis.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Ewing's sarcoma (EwS) frequently metastasizes to the lungs. While whole-lung irradiation (WLI) improves survival, conventional techniques carry a risk of cardiac toxicity. Helical Tomotherapy (HT) offers superior target conformity and the ability to deliver a simultaneous integrated boost (SIB) to metastases. This case series evaluates the feasibility and short-term outcomes of HT-based WLI with SIB in patients with pulmonary metastatic EwS, with a focus on the challenges encountered across a variety of complex clinical scenarios. Case description: We report on five patients (3 male, 2 female; age range 15-36 years, mean age 24.2 years) with pulmonary/pleural metastases who received HT-based WLI (12-15 Gy/10 fractions) with SIB to thoracic lesions (27-45 Gy). The cases are unique in their diversity: one patient with 36 bilateral lung metastases achieving complete response (Case 2), one with prior sternal SBRT developing grade 3 radiation pneumonitis (RP) on concurrent immunotherapy (Case 5; thoracic radiotherapy delivered to spatially distinct, non-overlapping target volumes), and one with pleural progression after multiple chemotherapy lines (Case 3). Concurrent therapies included anlotinib (n=4), sintilimab (n=1), or chemotherapy (n=1). With a median follow-up of 5.5 months (range 2-12.5), the overall response rate was 86.7% (59/68 lesions: 53 complete responses, 1 near-CR, 5 partial responses). Median lung/pleural progression-free survival was 5.5 months, with four patients surviving and one dying from extrapulmonary progression. Acute toxicity was manageable, including one case of grade 3 RP (resolved with steroids). Mean heart dose was 7.39 ± 0.81 Gy and lung V20 was 19.15 ± 5.03%. All plans achieved satisfactory target coverage with D95% ≥ prescription dose for both PTVall and PTVp. Conclusions: HT-based WLI with SIB provides excellent target coverage and satisfactory OAR sparing, is feasible and adaptable in complex settings, and achieves encouraging short-term local control in pulmonary metastatic Ewing's sarcoma; caution is warranted regarding radiation pneumonitis risk with concurrent immunotherapy.
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