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CASE REPORT
Year : 2020  |  Volume : 11  |  Issue : 3  |  Page : 115-119

Radiation treatment in a rare case of sinonasal ewing's sarcoma: A case report


Department of Advanced Centre for Radiation Oncology, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Gopal Pemmaraju
Department of Advanced Centre for Radiation Oncology, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrcr.jrcr_34_20

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Ewing's sarcoma of the nasal cavity and paranasal sinuses (PNS) is extremely rare and a very few cases have been reported so far.Diagnosing Ewing's sarcoma requires the use of radiological studies, histopathological examination, immunohistochemistry(IHC), and cytogenetic studies.CD 99 or Mic 2 membranous expression on Immunohistochemistry and antibody against FLI 1 are the hallmark in the diagnosis of Ewing's sarcoma.Management of sinonasal Ewing's sarcoma includes surgery,chemotherapy and radiotherapy. Radiation treatment plays an important role in the treatment of Ewing's sarcoma as an adjuvant treatment. We are reporting a case of a 9 year old female child presented with complaints of epistaxis, nasal obstruction and swelling over right side of the face. Biopsy of the right sino nasal mass was done. Histopathologically the tumour composed of sheets of ovo-sphenoid cells.IHC showed positivity for Mic-2 and p53 protein.PET-CT scan showed an FDG avid uniformly enhancing soft tissue mass around 7.7x3.4x5.8 centimetres involving the nasopharynx, sphenoid bone,sphenoid sinus,ethmoid sinus, maxillary sinus,nasal cavity,infiltration through the optic canal into the right orbit with intracranial extension.Patient underwent Neo-adjuvant chemotherapy with Ewing's Family Tree EFT(Ewing's Family Tree)-2001 protocol and had complete response on assessment.We treated the patient with adjuvant radiation treatment to a dose of 52 Gy in 29 fractions (1.8 Gy/fraction) over 6 week to the pre-chemo tumour bed by VMAT technique..No major acute toxicities were noticed during the course of treatment. Patient needs to be assessed for local control and late toxicities. A multidisciplinary team approach involving oncosurgery, medical oncology and radiation oncology is very crucial in attaining better outcomes.Radiation as an adjuvant treatment helps us in achieving better local control and disease free survival.Radiation techniques like VMAT,IMRT can deliver treatment with homogenous dose distribution within target and sparing organs at risk.


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