What is the role of local control +/- whole lung irradiation in a patient with relapsed/refractory Ewing sarcoma to the hilum plus multiple lung nodules?

Patient initially achieved CR with VAC-IE with resolution of presumed lung mets and 100% necrosis in LLE primary tumor on BKA. Then was NED again after VIT and Auto-SCT with two year disease free interval between each treatment course. Currently relapsed with a large hilar mass and scattered 3mm ipsilateral pulmonary nodules.

Would you offer radiation? Any role for whole lung vs hilar mass radiation?

Answer from: Radiation Oncologist at Academic Institution

I would boost residual thoracic disease to at least the usual Ewings gross disease dose of 55.8 (total, including WLI dose). Doses in this range are well known to be safe in the thorax and this multiply relapsed disease is likely to be more treatment refractory than primary disease. SBRT boost seems...

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Radiation Oncologist at Shariati Hospital, Tehran Universit of Medical Sciences
If the boost is given through SBRT technique, how ...

Answer from: Radiation Oncologist at Academic Institution

I would do whole lung and boost to hilar nodes, given prior history.

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Radiation Oncologist at Penn State Cancer Institute, Penn State Milton S. Hershey Medical Center
What dose would you boost the nodules to afterward...

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What is the role of local control +/- whole lung irradiation in a patient with relapsed/refractory Ewing sarcoma to the hilum plus multiple lung nodules?

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