Table 3.
Studies of stereotactic body radiotherapy for pediatric sarcomas.
| Study (Treatment years) | Number of patients | Patient population | Radiotherapy site and dose | Systemic therapy | Local control and survival | Toxicity |
|---|---|---|---|---|---|---|
| Brown et al. (88) (2008-2012) | N=14 (27 lesions) | Retrospective study of pediatric and adult patients with metastatic or recurrent ES or osteosarcoma | Sites: Bone and lung/mediastinal Dose: Median 40 Gy in 5 fractions (range, 16-60 Gy in 1-10 fractions) |
Concurrent chemotherapy in 50% of patients (n=4 with I/E, n=2 with VCR, topotecan, CP, n=1 with GEM/docetaxel, n=1 with CP/topotecan) | 2-year LC: 85% | No grade ≥3 acute toxicity N=3 grade ≥2 late toxicity: sacral plexopathy (re-RT), myonecrosis (concurrent GEM), pathologic fracture/AVN |
| Liu et al. (89) (2017-2018) |
N=5 (8 lesions) | Phase I/II study of patients ≤21 years with lung metastases from sarcoma | Sites: Lung metastases Dose: 30 Gy in 3 fractions |
Concurrent systemic therapy in 1 patient (nivolumab) | 2-year LC: 60% | No grade ≥3 adverse events N=1 grade ≥2 pneumonitis (concurrent nivolumab) |
| Elledge et al. (90) (2014-2018) |
N=14 (37 lesions) | Phase II study of patients age 4-25 years with unresected, osseous metastatic non-RMS sarcomas of soft tissue and bone | Sites: Osseous metastases (spine, extremity, pelvis, skull) Dose: 40 Gy in 5 fractions |
No systemic therapy within 2 weeks before or after SBRT | 2-year LC: 89% (patient), 95% (lesion) Median PFS: 6 months Median OS: 24 months |
N=2 grade ≥3 toxicity: esophagitis, osteoporosis/necrosis |
| Parsai et al. (91) (2014-2019) |
N=31 (88 lesions) | Retrospective study of patients age 4-29 with recurrent or metastatic sarcomas | Sites: Osseous, pulmonary, soft tissue, hepatic Dose: Median 30 Gy in 5 fractions (range, 16-60 Gy in 1-5 fractions) |
Concurrent systemic therapy with treatment of 56% of lesions (multiple agents) | 1-year LC: 83% | No grade ≥3 acute toxicity N=2 grade ≥2 late toxicity: radiation enteritis (re-RT and concurrent I/E/CARBO), pain (concurrent Ra-223/sorafenib) N=2 radiation recall: dermatitis (I, mesna), myositis (paclitaxel, GEM, BEV) |
AVN, avascular necrosis; BEV, bevacizumab; CARBO, carboplatin; CP, cyclophosphamide; E, etoposide; ES, Ewing sarcoma; GEM, gemcitabine; Gy, Gray; I, ifosfamide; LC, local control; OS, overall survival; PFS, progression-free survival; re-RT, re-irradiation; RMS, rhabdomyosarcoma; SBRT, stereotactic body radiotherapy; VCR, vincristine.