Treatment
Ewing's sarcoma is most often treated with a combination of chemotherapy, surgery, or radiation therapy if localized to one area, but if the sarcoma has spread then chemotherapy is the main treatment. Your physician may also discuss clinical trials with immunotherapy and targeted therapy as alternative treatment options. Doctors often start patients off on an intensive chemotherapy regimen. After chemotherapy, the patient undergoes either surgery and/or radiation therapy to remove the rest of the tumor. After these treatments, the patient usually receives more chemotherapy to destroy any remaining cancer cells.
Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Most of these medications are given through the vein (intravenously). Chemotherapy is usually the first treatment doctors give for Ewing's sarcoma. Chemotherapy may be given before and after surgery to increase the chances of a successful operation. Chemotherapy may also be given to patients whose cancer has metastasized (spread) to other parts of the body. Doctors rarely consider high dose chemotherapy with stem cell rescue in which chemotherapy is given to kill the cancer cells and the stem cell transplant that follows replaces the blood-forming cells killed during chemotherapy.
Surgery
Doctors often perform surgery to remove Ewing's sarcoma tumors after the patient finishes their initial regimen of chemotherapy. The doctor will try to remove only the tumor and as little of the affected bone as possible. Previously, the only surgical treatment option for patients with bone tumors in an arm or leg was amputation (removal of the limb). With new advances in surgical techniques, and the addition of chemotherapy and radiation, doctors can usually perform limb-sparing surgery for these patients. In this procedure, the doctor removes the tumor while saving nearby tendons, nerves and blood vessels, to allow the patient to retain use of the arm or leg. In some advanced cases where the cancer has invaded these structures, amputation may be the best option. After removing the tumor, the doctor replaces the extracted bone with a bone graft from another area of the body or an internal prosthetic replacement.
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Radiation Therapy
Radiation therapy uses waves of high-energy rays to target and kill cancer cells. Radiation therapy is not often used as a primary treatment for Ewing's sarcoma, but may be used after the patient's initial regimen of chemotherapy, if surgery is not an option, or at times in addition to surgery. Radiation therapy may also be used to relieve symptoms of the disease in patients with advanced Ewing's sarcoma.
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Proton beam radiation therapy
Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. It delivers a radiation dose to the cancer, but is thought to limit damage from the radiation to surrounding tissues. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects.
- Please see Understanding Proton Therapy for more information
Targeted Therapy
The term targeted therapy means that the treatment primarily affects genetic vulnerabilities in cancer cells. Unlike conventional chemotherapy, targeted therapy does not attack all rapidly dividing cells in the body, so it can spare normal tissue. Targeted therapy is intended to stop the growth of cancer cells by interfering with signals that cause the cancer to grow or continue to live. Targeted therapy does not work in all cases (primary resistance) or may work for some period and then stop working (acquired resistance). There are oral targeted therapies that are used in patients with Ewing's sarcoma that has spread after intravenous chemotherapy.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
