Objective:

To evaluate the feasibility and short-term outcomes of Helical Tomotherapy (HT)-based whole lung irradiation (WLI) with simultaneous integrated boost (SIB) specifically in patients with pulmonary metastatic Ewing’s sarcoma.

Key Findings:

• Overall response rate was 86.7% with 53 complete responses, 1 near-complete response, and 5 partial responses across a total of 68 lesions assessed.
• Median lung/pleural progression-free survival was 5.5 months.
• Acute toxicity was manageable; one case of grade 3 radiation pneumonitis resolved with steroids.
• Mean heart dose was 7.39 ± 0.81 Gy and lung V20 was 19.15 ± 5.03%.

Interpretation:

HT-based WLI with SIB is feasible and provides excellent target coverage and organ-at-risk sparing, achieving promising short-term local control in complex cases of pulmonary metastatic Ewing’s sarcoma, suggesting potential for future research.

Limitations:

• Small sample size limits generalizability.
• Short follow-up duration may not capture late toxicities or long-term outcomes.
• Potential biases inherent in retrospective study design.

Conclusion:

HT-WLI with SIB is a promising treatment approach for pulmonary metastatic Ewing’s sarcoma, though caution is advised regarding the risk of radiation pneumonitis, especially with concurrent immunotherapy, and further studies are needed to validate these findings.