Pencil beam scanned protons for the treatment of patients with Ewing sarcoma.

Weber, Damien Charles; Murray, Fritz R; Correia, Dora; Bolsi, Alessandra; Frei-Welte, Martina; Pica, Alessia; Lomax, Antony J; Schneider, Ralf; Bachtiary, Barbara (2017). Pencil beam scanned protons for the treatment of patients with Ewing sarcoma. Pediatric blood & cancer, 64(12) Wiley-Liss 10.1002/pbc.26688

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Few data exist regarding the clinical outcome of patients with Ewing sarcoma (EWS) treated with pencil beam scanning proton therapy (PT). We report the outcome of children, adolescents and young adults (AYA) treated with PT at the Paul Scherrer Institute.


Thirty-eight patients (median age, 9.9 years) received a median dose of 54.9 Gy(RBE) (where RBE is relative biologic effectiveness). Size of the tumor ranged from 1.7 to 24 cm. Most common primary site was axial/pelvic (n = 27; 71%). Four patients (11%) presented with metastases at diagnosis. Twenty (53%) patients had chemo-PT only. Median follow-up was 49.6 months (range, 9.2-131.7).


The 5-year actuarial rate of local control (LC), distant metastasis-free survival (DMFS), and overall survival (OS) were 81.5%, 76.4%, and 83.0%, respectively. All local recurrences occurred in field and in patients with nonextremity primaries. Six patients died, all of tumor progression. Age < 10 years was a favorable factor of borderline significance for LC (P = 0.05) and OS (P = 0.05), but was significant for DMFS (P = 0.003). Tumor volume <200 ml was a significant prognostic factors for DMFS (P = 0.03), but not for OS (P = 0.07). Metastasis at diagnosis was a strong predictor of local failure (P = 0.003). Only two grade 3 late toxicities were observed. The 5-year actuarial rate of grade 3 toxicity-free survival was 90.9%.


These preliminary data suggest that the outcomes of children and AYA with EWS are good and PT was well tolerated with few late adverse events. The local and distant tumor control for older patients with large pre-PT tumor volumes remains problematic.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Radiation Oncology

UniBE Contributor:

Weber, Damien Charles and Pica, Alessia


600 Technology > 610 Medicine & health








Beatrice Scheidegger

Date Deposited:

06 Mar 2018 17:16

Last Modified:

22 Oct 2019 19:36

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

AYA Ewing sarcoma children late toxicity local tumor control pencil beam scanned protons proton therapy




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