Treatment & Prognosis of Ewing Sarcoma (Charles)
Treatment & Prognosis of Ewing Sarcoma (Charles)
Treatment & Prognosis of Ewing Sarcoma (Charles)
The treatment for Ewings sarcoma is a multidisciplinary approach that focuses on three
treatment modalities namely, chemotherapy, surgery and radiotherapy.
Chemotherapy for the control of micro metastasis; surgery for the local control where
possible; and radiotherapy for the local control where surgery wasnt able or incompletely
controlled.
General Management
o Effective local and systemic chemotherapy is necessary for cure.
o Induction chemotherapy is preferred over starting the systemic and local therapy.
o Advantage of this approach:
Evaluation of the effectiveness of the regimen
Decreases the volume of local therapy for surgery or radiotherapy (RT)
And some bone healing occurs during chemotherapy (CT) Thereby
diminishing the risk of pathological fracture
Chemotherapy
o All patients require to undergo chemotherapy:
Induction chemotherapy
Maintenance chemotherapy
o Effective chemotherapy has improved local control rates achieve with radiation to
85-90%.
o
o
o
o
Surgery
o Preferred for potentially resectable lesions and for those arising in dispensable
bones (e.g. fibula, ribs, small lesions of the hands or feet) for the following
reasons:
Avoids risk of secondary radiation-induced sarcomas.
Analysis of the degree of necrosis in the excised tumor can permit
refinements in the estimate of prognosis.
In the skeletally immature child, resection may be associated with less
morbidity than radiation, which can retard bone growth and cause
deformity.
Tumors affecting the long bones of the leg, distal humerus, or ulna can
usually be resected and reconstructed using intercalary techniques
(allografts, autografts, or metallic prostheses) or joint replacement,
depending of the tumor location.
Radiotherapy
o Preferred in patients who:
Lack a function preserving surgical option because of tumor location or
extent
Those who have clearly unresectable primary tumors following induction
chemotherapy
Patients with lesions of the skull, facial bones, or vertebrae are often
candidates for nonsurgical treatment because of the difficulty in achieving
negative margins without substantial functional deficits.
Patients refusing surgery
o
Adjuvant radiotherapy:
Recommended if there is residual microscopic or gross disease after
surgery, or inadequate surgical margins.
Adjuvant hemithorax irradiation improves outcomes in patients with
high-risk chest wall primary tumors (close or involved margins, initial
pleural effusion, pleural infiltration, and intraoperative contamination of the
pleural space).
Surveillance
o Physical examination, local and chest imaging:
o Every 2-3 months
o Increase interval after 24 months
o Annually after 5 years indefinitely.
o CBC and other lab studies as indicated
o Consider Bone scan or PET scan
Prognosis of Ewing Sarcoma
Prognosis for Ewing sarcoma will depend upon pretreatment factors and response to
initial therapy factors.
Pretreatment factors:
Site of Tumor
o
o
o
o
Age
Gender
Serum LDH
o
Metastases
o
o
o
o
Response to CT
o
o
o