Ewing's sarcoma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.

Surgery

The types of treatments given are based on the unique needs of the person with cancer. Rather than using the standard staging system, a simpler system is often used when deciding treatment for Ewing sarcoma. This system divides Ewing sarcoma of the bone into 2 groups: localized and metastatic. The following are treatment options for all stages of Ewing sarcoma of the bone:

Localized Ewing sarcoma

With localized Ewing sarcoma, the cancer is only in the bone where it started and it has not spread to nearby lymph nodes. Standard treatment options for localized Ewing sarcoma include the following:

• Chemotherapy
• Local control measures:

• Surgery
• Radiation therapy

Chemotherapy

• Chemotherapy is the primary treatment for localized Ewing sarcoma.
• Chemotherapy is used because most people who appear to have localized disease have hidden (occult) metastatic disease.
• Chemotherapy is given before surgery or radiation therapy to:

• Treat possible micrometastases cancer cells that have spread from the original (primary) site to other parts of the body in such small amounts that screening or diagnostic tests cannot find them.
• Shrink the tumor.

• It is also given after surgery or radiation therapy to kill all remaining cancer cells.

Radiation

• Radiation therapy may be offered for localized Ewing sarcoma.
• Radiation is used instead of surgery if the tumor is in a location that makes it inoperable or if surgery would compromise the function.
• It may be given after surgery if the margins contain cancer cells or the surgeon could not remove a wide margin around the tumor.

Surgery

• Surgery may be offered for localized Ewing sarcoma following chemotherapy.
• The types of surgery that may be done include:

• Limb-sparing surgery
• Amputation
• ReconstructionPotential

• Benefits of surgery include the following:

• If a very young child has Ewing sarcoma, surgery may be a less-morbid therapy than radiation therapy because of the retardation of bone growth caused by radiation.
• Another potential benefit for surgical resection of the primary tumor is related to the amount of necrosis in the resected tumor. Patients with residual viable tumor in the resected specimen have a worse outcome than those with complete necrosis.

Metastatic Ewing sarcoma

Metastatic Ewing sarcoma has already spread to distant parts of the body at the time of diagnosis. It usually spreads to the lungs, other bones, or the bone marrow. Standard treatment options for metastatic Ewing sarcoma include the following:

• Chemotherapy
• Surgery
• Radiation therapy

Chemotherapy

• Chemotherapy is usually the first treatment for metastatic Ewing sarcoma.
• Standard treatment for patients with metastatic Ewing sarcoma utilizing alternating vincristine, doxorubicin, cyclophosphamide, and ifosfamide/etoposide combined with adequate local control measures applied to both primary and metastatic sites often results in complete or partial responses
• Radiation therapy may be given to the primary tumor and to the metastases.
• Whole lung irradiation may be given if there is lung metastasis.
• Surgery may be used to remove any visible Ewing sarcoma.