Radiation Therapy For Pediatric Head And Neck Ewing Sarcoma: A 13-Year Experience From a Tertiary Care University Hospital In Pakistan

Abstract

Objectives

Ewing's sarcoma(ES) in head and neck region is an uncommon yet challenging entity, and accounts for 1%-4% of all ES cases. Our study aims to assess the clinicodemographic and therapeutic features of pediatric patients irradiated for head and neck Ewing sarcoma (HN-ES) at our centre.

Methodology

This is a retrospective review of the medical records of patients aged ≤18 years, with histologically proven HN-ES irradiated at Radiation Oncology department of Aga Khan University Hospital, between 2010 – 2023. Clinico-demographic features including age, gender, head and neck subsite, and RT details such as intent, total RT dose, radiation treatment duration and treatment gaps were systematically collected and stored in password-protected datasheet.

Results

Total (n=20) pediatric patients with HN-ES underwent irradiation at our facility between 2010–2023. Majority were females(n=13), with a mean age of 9.5 years(±3.83). Three patients received RT under general anesthesia. Subsite involvement included orbit (n=5), mandible (n=4), paranasal sinus (n=2), pharynx (n=2), and scalp (n=2), with cervical spine, nasal cavity, maxilla, and mastoid each affected in one case. Definitive RT was provided to 17 patients, while adjuvant RT was administered to n=3 patients. Intensity-modulated radiation therapy(n=13) was the most common planning technique, followed by Volumetric-arc therapy (n=4) and three-dimensional conformal RT(n=3). The mean radiation dose was 5360 cGy, with a regimen of 5580 cGy/31 fractions being predominant(n=14). Eleven patients had a single-phase RT plan, while nine had a two-phase plan. The mean treatment duration was 51.25 days, with treatment gaps identified in n=15 patients, primarily attributed to neutropenia(n=8), and infective causes(n=7), with a median duration of 5 days(range:1–14 days).

Conclusion

HN-ES is exceedingly rare, and even small single-center experiences contribute to the growing body of evidence. Managing HN-ES poses significant challenges in achieving local control while preserving functional outcomes, underscoring the importance of multidisciplinary care.