Abstract

Introduction: Ewing’s sarcoma (ES) is a rare but highly aggressive malignancy, predominantly affecting children and young adults, with a characteristic presentation of bone or soft tissue involvement. Whole lung irradiation (WLI) is used in the treatment of pulmonary metastases, especially following chemotherapy and surgical resection of the primary tumor. The purpose of this study was to assess the effectiveness of whole-lung irradiation in a young adult patient with metastatic Ewing’s sarcoma. Patient Information & Systemic Therapy: A young adult with progressively worsening tibial pain and swelling was diagnosed with Ewing’s sarcoma after imaging and biopsy confirmed the presence of the tumor. Neoadjuvant chemotherapy (VAC/IE) was administered, followed by surgical resection of the femoral tumor. Interim imaging showed significant reduction in pulmonary metastases, prompting the decision to proceed with whole lung irradiation. Material and Methods: The patient underwent whole-lung irradiation using a high-precision radiation therapy technique. A thermoplastic mask was employed for immobilization during CT scanning and radiation treatment. The radiation planning utilized Varian Somavision for tumor volume delineation, and the treatment plan was created using IMRT (Intensity-Modulated Radiation Therapy) with a Halcyon Elite 4.0 machine. The patient was treated with 18 Gy in 12 fractions. The breath-hold technique was utilized to minimize respiratory motion during radiation delivery. Cone Beam CT (CBCT) and portal dosimetry were employed to verify treatment accuracy. Results: The radiation dose was successfully delivered to the target volume (PTV), with a high degree of precision, as evidenced by dosimetric parameters. The V95% was above 95%, indicating that 95% of the target volume received the prescribed dose. The homogeneity index (P-HI) and conformity index (CI) showed favorable dose distribution, ensuring the target volume received a uniform dose while sparing surrounding healthy tissues. Critical organs such as the heart, esophagus, and liver received doses within safe limits, and no significant adverse effects were observed. Conclusion: Whole-lung irradiation using IMRT and advanced techniques like the breath-hold method and cone beam CT verification represents a promising strategy for managing pulmonary metastases in Ewing’s sarcoma. This individualized treatment plan maximized the therapeutic dose to metastatic lesions while minimizing risks to healthy organs, highlighting the potential for optimizing radiation therapy in this patient population.

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