Radiation therapy dose escalation achieves high rates of local control with tolerable toxicity profile in pediatric and young adult patients with Ewing sarcoma

Abstract Background Local control for patients with Ewing sarcoma (EWS) who present with large tumors are suboptimal when treated with standard radiation therapy (RT) doses of 54–55.8 Gy. The purpose of this study is to determine local control and toxicity of dose‐escalated RT for tumors ≥8 cm (greatest diameter at diagnosis) in pediatric and young adult patients with EWS. Methods Eligible patients ≤30 years old with newly diagnosed EWS ≥8 cm treated with definitive conformal or intensity modulated photon, or proton radiation therapy techniques were included. All patients in the study received dose‐escalated RT doses. Outcomes included overall survival (OS), event‐free survival (EFS), local failure rates, and toxicity. Results Thirty‐two patients were included, 20 patients presented with metastatic disease and 12 patients with localized disease. The median RT dose was 64.8 Gy (range, 59.4–69.4 Gy) with variability of doses to protect normal surrounding tissues. All patients received systemic chemotherapy. The 5‐year OS and EFS for the cohort was 64.2% and 42%, respectively. The 5‐year cumulative incidence of local failure was 6.6%. There were two combined local and distant failures with no isolated local failures. Twenty‐nine patients experienced short term toxicity, 90% of those being radiation dermatitis. Twenty‐seven patients experienced long‐term toxicity, with only one experiencing grade 4 toxicity, a secondary malignancy after therapy. Conclusion This study demonstrates that definitive RT for pediatric and young adult patients with EWS ≥8 cm provides high rates of local control, while maintaining a tolerable toxicity profile.