Esophagitis associated with multimodality management of pediatric Ewing sarcoma of thorax
- PMID: 29431250
- DOI: 10.1002/pbc.27006
Esophagitis associated with multimodality management of pediatric Ewing sarcoma of thorax
Abstract
Background: Ewing sarcoma of the thoracic spine and chest wall is frequently treated with concurrent chemotherapy and radiation therapy (RT). Treatment-related acute esophagitis can lead to hospitalization and treatment delays. The aim of this study was to analyze the incidence, risk factors, and management of esophagitis in pediatric patients with Ewing sarcoma of the thoracic region.
Methods: We conducted a single-institution retrospective review of patients treated over a 10-year period. Medical records were reviewed for patient and treatment characteristics associated with Common Terminology Criteria for Adverse Events grade 2 or higher esophagitis. RT plans were also reviewed and various esophageal dose metrics were analyzed.
Results: Twelve of 37 patients (32%) developed acute esophagitis. Neutropenia was associated with an increased risk of esophagitis (60% vs. 14%; P < 0.01). RT significantly contributed to its incidence when maximum esophageal dose was >47 Gy (69% vs. 5%; P < 0.0001) and esophageal D5cm3 was >15 Gy (67% vs. 9%; P < 0.001). All 12 patients with esophagitis were managed with oral opioid analgesics. Nine patients with persistent symptoms received subsequent fluconazole for empiric fungal treatment and each had a decreased need for opioid analgesics within 2-5 days.
Conclusion: Approximately one-third of patients with Ewing sarcoma of the thoracic region will develop acute esophagitis. An esophageal D5cm3 dose < 15 Gy and maximal esophageal dose < 47 Gy may keep the rate of acute esophagitis under 5%. However, the association with neutropenia and consistent response to antifungal therapy suggest chemotherapy-associated toxicity and an infectious component as part of the process.
Keywords: Ewing sarcoma; disease management; esophagitis; radiation therapy; thorax.
© 2018 Wiley Periodicals, Inc.
Similar articles
-
Treatment and outcome of patients with thoracic tumors of the Ewing sarcoma family: A report from the Cooperative Weichteilsarkom Studiengruppe CWS-81, -86, -91, -96, and -2002P trials.Pediatr Blood Cancer. 2019 Mar;66(3):e27537. doi: 10.1002/pbc.27537. Epub 2018 Nov 12. Pediatr Blood Cancer. 2019. Corrected and republished in: Pediatr Blood Cancer. 2019 Aug;66 Suppl 3:e27884. doi: 10.1002/pbc.27884. PMID: 30421578 Corrected and republished.
-
Local control in Ewing sarcoma of the chest wall: results of the EURO-EWING 99 trial.Ann Surg Oncol. 2015 Sep;22(9):2853-9. doi: 10.1245/s10434-015-4630-0. Epub 2015 Jun 24. Ann Surg Oncol. 2015. PMID: 26104542 Clinical Trial.
-
Treatment-related acute esophagitis for patients with locoregionally advanced non-small cell lung cancer treated with involved-field radiotherapy and concurrent chemotherapy.Am J Clin Oncol. 2014 Oct;37(5):433-7. doi: 10.1097/COC.0b013e31827de7a2. Am J Clin Oncol. 2014. PMID: 23388558
-
Primary cutaneous Ewing sarcoma: a systematic review focused on treatment and outcome.Br J Dermatol. 2012 Apr;166(4):721-6. doi: 10.1111/j.1365-2133.2011.10743.x. Epub 2012 Mar 5. Br J Dermatol. 2012. PMID: 22098102 Review.
-
Ewing sarcoma.Pediatr Blood Cancer. 2021 May;68 Suppl 2:e28355. doi: 10.1002/pbc.28355. Pediatr Blood Cancer. 2021. PMID: 33818887 Review.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical