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Treatments for childhood Ewing sarcoma of the bone

The healthcare team will create a treatment plan just for your child. It will be based on your child’s needs and may include a combination of different treatments for Ewing sarcoma of the bone.

Treatment is usually based on the stage of childhood bone cancer. When deciding which treatments to offer for Ewing sarcoma of the bone, your child’s healthcare team will also consider the:

  • location and size of the tumour
  • child’s age
  • child’s lifestyle and activity level

Treatments for localized childhood Ewing sarcoma of the bone

Chemotherapy is often the first treatment for localized Ewing sarcoma of the bone. It is given before surgery or radiation therapy. This is called neoadjuvant chemotherapy. Neoadjuvant chemotherapy is usually given for 8–12 weeks.

After at least 12 weeks of neoadjuvant chemotherapy, doctors will use imaging tests, such as MRI and CT scans, to reassess the tumour. They will check if the tumour is shrinking and if it can be removed with surgery (is resectable).

If the tumour is not growing and it is resectable, surgery is done to remove the tumour. The surgeon will try to remove the tumour along with a margin of healthy tissue around it. If the tissue removed along with the tumour doesn’t contain cancer cells (called clear, or negative, surgical margins), chemotherapy alone is given to kill any cancer cells left behind. This is called adjuvant chemotherapy. If there are cancer cells in the tissue removed along with the tumour (called positive surgical margins), radiation therapy is given along with chemotherapy.

If the tumour is not growing but it is not resectable, radiation therapy will be given to treat the tumour. During and after radiation, chemotherapy will be given for another 24 weeks.

If the tumour is still growing, a different combination of chemotherapy drugs may be given. Surgery or radiation therapy may be used to control the growth of the tumour.

Chemotherapy

The most common combination of chemotherapy drugs used for localized Ewing sarcoma of the bone is:

  • vincristine (Oncovin), doxorubicin (Adriamycin), cyclophosphamide (Cytoxan, Procytox), etoposide (Vepesid, VP-16) and ifosfamide (Ifex)

When cyclophosphamide or ifosfamide is used, mesna (Uromitexan) is also given. Mesna helps protect the bladder from irritation from cyclophosphamide or ifosfamide.

Surgery

After chemotherapy (and sometimes radiation therapy), surgery is used to remove the tumour. It may also be used to rebuild the bone.

Radiation therapy

Radiation therapy may be used to treat the tumour when surgery is not possible. Also, radiation may be used after surgery if a clear margin is not obtained.

Treatments for metastatic Ewing sarcoma of the bone

Metastatic Ewing sarcoma of the bone is usually treated with chemotherapy along with surgery or radiation therapy.

Chemotherapy

Chemotherapy is the primary treatment for metastatic Ewing sarcoma of the bone. It is given for 12–16 weeks. After at least 12 weeks of chemotherapy, doctors will use imaging tests, such as MRI and CT scans, to reassess the tumour. They will check how well the cancer responded to treatment.

Chemotherapy combinations used include:

  • vincristine, doxorubicin, cyclophosphamide, etoposide and ifosfamide

When cyclophosphamide or ifosfamide is used, mesna (Uromitexan) is also given. Mesna helps protect the bladder from irritation from cyclophosphamide or ifosfamide.

Surgery

Surgery may be used to remove the primary tumour and metastases in other bones or a lung. It is done after chemotherapy (or radiation therapy, in some cases) if the cancer has spread to only a few small areas.

Radiation therapy

Radiation therapy may be used before surgery, after surgery or alone. It may be given to the primary tumour as well as to metastatic sites, such as other bones or a lung.

Radiation therapy may be given to bone metastases to relieve symptoms (called palliative therapy). It may also be given to treat lung metastases.

Chemotherapy may be given at the same time as radiation therapy.

Treatments for recurrent childhood Ewing sarcoma of the bone

The treatments offered for recurrent childhood Ewing sarcoma of the bone are based on:

  • whether the recurrence is local (close to the primary site) or metastatic (in another part of the body)
  • what treatments the child has already received
  • how long since the child’s last treatment

Recurrent Ewing sarcoma of the bone may be treated with chemotherapy, surgery, radiation therapy or a combination of these treatments.

 

Chemotherapy with one or more of the following drug combinations may be given, depending on what chemotherapy the child has already received:

  • cyclophosphamide and topotecan (Hycamtin)
  • temozolomide (Temodal) and irinotecan (Camptosar)
  • temozolomide, irinotecan and vincristine
  • gemcitabine (Gemzar) and docetaxel (Taxotere)

 

Surgery may be used to remove recurrent tumours in the bone.

Radiation therapy may be given to relieve symptoms of recurrent childhood Ewing sarcoma (called palliative therapy). It may be used to treat cancer that has spread to other bones and the lung.

Follow-up care

Follow-up after treatment is an important part of cancer care. Your child will need to have regular follow-up visits, especially in the first 10 years after treatment has finished. These visits allow your child’s healthcare team to monitor your child’s progress and recovery from treatment.

Clinical trials

Many children with Ewing sarcoma of the bone are treated in a clinical trial that is tailored to the stage and type of cancer. The clinical trial protocol, or plan, outlines the treatments, such as the chemotherapy drugs and dosages used. Find out more about clinical trials.

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