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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 volume 45, pages 483–489 (2010)Cite this article

Abstract

We examined the role of total body magnetic resonance imaging (TB-MRI)-governed involved compartment irradiation (ICI) and high-dose chemotherapy (HDC), followed by stem cell rescue (SCR) in patients with high-risk Ewing tumors (ETs) with multiple primary bone metastases (high-risk ET-MBM). Eleven patients with high-risk ET-MBM receiving initial assessment of involved bones by TB-MRI were registered from 1995 to 2000 (group A). In all, 6 patients out of 11 had additional lung disease at initial diagnosis; all had multifocal bone disease with more than three bones involved. After systemic induction with etoposide, vincristine, adriamycin (doxorubicin), ifosfamide, and actinomycin D (EVAIA) or VAIA chemotherapy, ICI of all sites positive by TB-MRI was administered, followed by HDC and SCR. A second group matched for observation period and consisting of 26 patients with more than three involved bones at diagnosis was treated with the European Intergroup Cooperative Ewing Sarcoma Study-92 (EICESS-92) protocol (group B). These patients did not receive TB-MRI and consequently did not receive TB-MRI-governed ICI, or HDC and SCR. Survival in group A vs group B was 45 vs 8% at 5 years and 27 vs 8% at 10 years after diagnosis (log rank and Breslow: P<0.005). We conclude that TB-MRI-governed ICI followed by HDC and SCR in ET-MBM is feasible and warrants further evaluation in prospective studies.

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Acknowledgements

We thank B Metzner, Klinikum Oldenburg, Department of Hematology and Oncology, Oldenburg, and B Kremens, Department of Pediatric Hematology-Oncology, University of Essen, Essen; and the respective institutions for their participation in the study. This study was supported by unrestricted grants to SB from the Wilhelm Sander-Stiftung (2006.109.1), Else Kroener–Fresenius–Stiftung (P31/08//A123/07), BMBF (TranSarNet FK:01GM0870), AmGen and Chugai.

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Authors and Affiliations

  1. Department of Pediatrics, Technische Universität München, and Pediatric Oncology Center, Munich, Germany

    S Burdach, U Thiel, M Schöniger, A Wawer & M Nathrath

  2. Department of Pediatric Hematology/Oncology, Martin-Luther University Halle-Wittenberg, Halle, Germany

    R Haase

  3. CCG Osteosarcoma, Helmholtz Zentrum München, Munich, Germany

    M Nathrath

  4. Department of Pediatric Hematology and Oncology University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    H Kabisch

  5. Department of Pediatrics, Medical University of Graz, Graz, Austria

    C Urban

  6. Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany

    H J Laws

  7. Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany

    U Dirksen & H Jürgens

  8. Department of Pediatric Radiology, Schwabing Hospital Medical Center, Munich, Germany

    M Steinborn

  9. Department of Radiotherapy, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

    J Dunst

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on behalf of the Meta-EICESS Study Group

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Correspondence to S Burdach.

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Burdach, S., Thiel, U., Schöniger, 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 Transplant 45, 483–489 (2010). https://doi.org/10.1038/bmt.2009.184

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