A treatment program for Ewing sarcoma may include several approaches such as surgery, radiation and chemotherapy. 

Surgery
Surgery is used to remove a tumor or remove any tumor left after chemotherapy. The tumor is either removed initially or after a few courses of chemotherapy. Surgery is performed when complete removal of the tumor is possible without damage to vital tissue or organs.

Radiation Therapy
Radiation therapy is a painless procedure similar to X-rays. During therapy, a machine aims beams of high-energy X-rays at the cancer site to kill tumor cells. Some normal cells are damaged as well, but healthy cells have a greater ability to repair damage than do tumor cells.

The goal is to damage normal cells as little as possible, while injuring tumor cells so they die or are unable to repair or reproduce themselves. Radiation therapy is used in combination with chemotherapy and sometimes surgery. Radiation for these tumors usually is given from outside the body. Studies are evaluating the effectiveness of radiation implanted in the body during surgery.

Chemotherapy
Chemotherapy is used to kill the primary tumor and any unknown microscopic spread.

Chemotherapy uses multiple medications. The most common agents are vincristine (Oncovin®), dactinomycin (Actinomycin D®), cyclophosphamide (Cytoxan®), and doxorubicin (Adriamycin®). Recent evidence shows the addition of ifosfamide (Ifex®) and etoposide (VePesid®, VP-16) helps. Chemotherapy is given through an indwelling central venous catheter. This is placed just before treatment is started.

Chemotherapy is done in cycles. It uses combinations of the various drugs. The time between cycles lets the blood cell count recover. This includes white blood cells and platelets. The drugs depress them. The patient will lose their hair. Various medications can lessen other side effects, such as nausea, mouth sores and fevers.

It generally takes close to one year to finish all the cycles of chemotherapy, with surgery and/or radiation. A doctor will look at the effect of chemotherapy. He or she will evaluate the number of cells killed in the tumor after it has been removed. This happens following several cycles of chemotherapy that may shrink the tumor. Many advances in chemotherapy have been made through knowledge gained by placing patients in clinical trials. Your doctor can tell you more. A physician may request permission to enroll a patient in a specific clinical trial.

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