Ewing Sarcoma: Treatment Choices

There are many treatment choices for Ewing sarcoma. The one that's best for you or your child depends on things such as:

• The type of Ewing sarcoma

• The size of the tumor and where it is in the body

• If the cancer has spread to other parts of the body

• Your or your child's age and overall health

• Personal concerns and preferences, such as what side effects you or your child will find acceptable

Learning about your treatment choices

You may have questions and concerns about treatment choices. You may want to know how you or child will feel and how you or your child will look. You may also want to know how your body or that of your child will work after treatment, and if you or your child will have to change normal activities.

Your healthcare provider is the best person to answer your questions. They can explain what the treatment choices are, how well they’re expected to work, and what the risks and side effects may be.

Your provider may advise a certain treatment. Or they may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It’s important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your choices. You may want to get a second opinion before deciding on a treatment plan. You may also want to include your family or friends in this process.

Goals of treatment for Ewing sarcoma

The main goal in treating Ewing sarcoma is to try to cure the cancer. If cure isn’t possible, treatment may help shrink the cancer or keep it under control for as long as possible. It can also improve quality of life by helping to control the symptoms of the disease. The goals of treatment can include one or more of these things:

• Remove the main tumor while doing as little damage as possible to nearby areas

• Remove or destroy tumors in other parts of the body

• Kill cancer cells or keep them from growing or spreading

• Keep the cancer from coming back or delay its return

• Ease symptoms of the cancer, such as pain or pressure in nearby tissues

As much as possible, other treatment goals include keeping normal function of the affected part of the body and limiting long-term side effects and complications.

Each type of treatment has a different goal. Talk with your healthcare provider about treatment goals so you know what to expect.

Types of treatment for Ewing sarcoma

Many different types of treatment can be used for Ewing sarcoma. Treatment for cancer is either local or systemic. These are the treatments commonly used for Ewing sarcoma:

• Local treatments. These remove, destroy, or control cancer cells in a certain place in the body. Surgery and radiation are local treatments.

• Systemic treatments. These destroy or control cancer cells all over the body. Chemotherapy and targeted therapy are examples.

In most cases, a combination of treatments is used to make sure all of the cancer cells have been removed or destroyed.

Chemotherapy

Chemotherapy (chemo) is the use of strong medicines to kill cancer cells. It's often the first treatment for Ewing sarcoma. The goal of chemo is to kill cancer cells and stop the cancer from growing or spreading. It can help shrink tumors so they're easier to take out with surgery or destroy with radiation. Chemo may also be used after surgery or radiation to kill any remaining cancer cells. The medicines are given into the bloodstream so they can reach cancer cells all over the body.

Chemo is a key part of the treatment for Ewing sarcoma. This is because even if it looks like the cancer is only in the bone, cancer cells have often already spread to other parts of the body.

Surgery

Surgery is another important part of the treatment for Ewing sarcoma. It’s often done after chemo (and sometimes after radiation). The goal is to take out the tumor along with an edge of healthy tissue around it. Any cancer cells that may have spread to nearby tissue may be removed, too. Sometimes surgery might also be used to treat cancer that’s spread to other parts of the body.

Radiation therapy

Radiation uses high-energy X-rays to kill cancer cells. It might be used before surgery to help shrink the tumor. After surgery, it can be used to kill any cancer cells that may be left behind. It can also be used to treat areas of cancer spread in other parts of the body.

High-dose chemo and stem cell transplant

This type of treatment might be a choice if other treatments have not cured the cancer or if the cancer comes back after treatment. It's mostly done as part of a clinical trial. The goal is to destroy all of the cancer cells in the body. First, very high doses of chemo are given. These high doses kill the stem cells in the bone marrow as well as the cancer cells. This is followed by an infusion of blood stem cells. The stem cells help rebuild the bone marrow, which is where new blood cells are made.

Clinical trials for new treatments

Researchers are always looking for new ways to treat Ewing sarcoma. These new methods are tested in clinical trials. Taking part in a clinical trial means you or your child gets the best treatment currently available. You might also get new treatments that are thought to be even better. Before starting treatment, talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare provider

At first, thinking about treatment choices may seem overwhelming. Talk with your healthcare providers and loved ones. Make a list of questions. Consider the benefits and possible side effects of each choice. Understand the long-term changes that each treatment could cause. Discuss any concerns with your healthcare provider before making a decision.