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Ewing's sarcoma (EWS) is the second most common primary bone tumor seen in children and adolescents, first being osteosarcoma. Skull lesions are seen in 6 to 9% of cases. The tumor tends to reside most frequently on frontal and parietal bones. In the literature, majority of papers on calvarial EWS present cases with intracranial involvement; extracranial extension is reported in only eight cases. The case that we are presenting in this report is a 23-year-old male patient with multiple infiltrations in femur, costal bones, and calvarium which had been diagnosed radiologically and histopathologically as EWS. The calvarial metastasis had reached a very huge size with dimensions of approximately 7.5 × 7.5 × 9.5 cm and was successfully excised totally. Twelve months of follow-up revealed no recurrence in the surgical site showing that total removal of giant cranial EWS may improve morbidity of these patients.

Abstract: Background and Purpose: This study summarizes the cranial stereotactic radiosurgery (SRS) volumetric modulated arc therapy (VMAT) procedure at our institution. Materials and Methods: Volumetric modulated arc therapy plans were generated for 40 patients with 188 lesions (range 2–8, median 5) in Eclipse and treated on a TrueBeam STx. Limitations of the custom beam model outside the central 2.5 mm leaves necessitated more than one isocenter pending the spatial distribution of lesions. Two to nine arcs were used per isocenter. Conformity index (CI), gradient index (GI) and target dose heterogeneity index (HI) were determined for each lesion. Dose to critical structures and treatment times are reported. Results: Lesion size ranged 0.05–17.74 cm3 (median 0.77 cm3), and total tumor volume per case ranged 1.09–26.95 cm3 (median 7.11 cm3). For each lesion, HI ranged 1.2–1.5 (median 1.3), CI ranged 1.0–2.9 (median 1.2), and GI ranged 2.5–8.4 (median 4.4). By correlating GI to PTV volume a predicted GI = 4/PTV0.2 was determined and implemented in a script in Eclipse and used for plan evaluation. Brain volume receiving 7 Gy (V7 Gy) ranged 10–136 cm3 (median 42 cm3). Total treatment time ranged 24–138 min (median 61 min). Conclusions: Volumetric modulated arc therapy provide plans with steep dose gradients around the targets and low dose to critical structures, and VMAT treatment is delivered in a shorter time than conventional methods using one isocenter per lesion. To further improve VMAT planning for multiple cranial metastases, better tools to shorten planning time are needed. The most significant improvement would come from better dose modeling in Eclipse, possibly by allowing for customizing the dynamic leaf gap (DLG) for a special SRS model and not limit to one DLG per energy per treatment machine and thereby remove the limitation on the Y‐jaw and allow planning with a single isocenter. [ABSTRACT FROM AUTHOR]

Purpose: To present a large experience (73 patients) using a standard radiotherapy (RT) protocol to prevent relapse in cranial sites where measurable metastatic neuroblastoma (NB), an adverse prognostic marker, is common. Methods and Materials: High-risk NB patients with measurable cranial disease at diagnosis or residual cranial disease after induction therapy had those sites irradiated with hyperfractionated 21 Gy; a brain-sparing technique was used for an extensive field. The patients were grouped according to the response to systemic therapy. Thus, when irradiated, Group 1 patients were in complete remission and Group 2 patients had primary refractory disease. Follow-up was from the start of cranial RT. Results: At 3 years, the 39 Group 1 patients had a progression-free survival rate of 51%; control of cranial disease was 79%. Two relapses involved irradiated cranial sites. Two other patients relapsed in the irradiated cranial sites 6 and 12 months after a systemic relapse. At 3 years, the 34 Group 2 patients had a progression-free survival rate of 33%; control of cranial disease was 52%. Group 2 included 19 patients who had residual cranial (with or without extracranial) disease. The cranial sites showed major (n = 13), minor (n = 2), or no response (n = 4) to RT. Five patients had progression in the cranial RT field at 10–27 months. Group 2 also included 15 patients who had persistent NB in extracranial, but not cranial, sites. Of these 15 patients, 2 relapsed in the irradiated cranial sites and elsewhere at 8 and 14 months. Cranial RT was well tolerated, with no Grade 2 or greater toxicity. Conclusion: Hyperfractionated 21-Gy cranial RT might help control NB and is feasible without significant toxicity in children. [Copyright &y& Elsevier]

Abstract: Aims: In small-cell lung cancer (SCLC), prophylactic cranial irradiation (PCI) provides a survival advantage in good performance status patients with limited disease. Its role in those with poor performance status limited disease or extensive disease is unclear. A low-dose PCI schedule has been used in these groups, and outcomes have been analysed. Materials and methods: Retrospective analyses of brain metastasis-free survival and overall survival of patients receiving low-dose PCI over a 2-year period. Results: Fifty-six patients were treated, with 55 evaluable due to missing notes for one. No major treatment-related toxicity was observed. Median brain metastasis-free survival and overall survival for the group were 44 and 46 weeks, respectively. The median brain metastasis-free survival were 32 and 50 weeks, and median overall survival were 39 and 57 weeks, in those with extensive and limited disease, respectively. A total of 10 patients developed clinical or radiological evidence of brain metastases, four (16%) with limited disease and six (21%) with extensive disease. Thirteen (52%) with limited disease and 10 (36%) with extensive disease survived 1 year. Conclusions: Symptomatic brain metastases occurred less frequently than would be expected, with most patients developing widespread metastatic disease. Low-dose PCI may benefit these groups, and the results of an ongoing EORTC randomised-controlled trial in extensive disease should provide more information. [Copyright &y& Elsevier]