How high is the risk of relapse? | Ewing sarcoma

How high is the risk of relapse?

The 5-year survival rate is 50% on average. Here one can assume that it is an aggressive and malignant cancer. The 5-year survival rate indicates that on average half of all diagnosed Ewing sarcomas lead to death. If, however, after 5 years of successful treatment of Ewing sarcoma, no further findings can be detected, the cancer is considered to be cured.

Aftercare

Recommendations:

  • In years 1 and 2:a clinical examination should be performed at three-month intervals. This usually includes a local X-ray checkup, laboratory tests, a CT of the thorax and a whole-body skeletal scintigraphy. Once every six months a local MRI is usually performed.
  • In the year 3 to 5:a clinical examination should be performed at six-month intervals. This usually includes a local X-ray check, laboratory tests, a CT of the thorax and a whole-body skeletal scintigraphy. Once a year a local MRI is usually performed.
  • From year 6 onwards, the following examinations are usually performed once a year: an X-ray with laboratory examination and a CT of the thorax as well as a whole-body skeletal scintigraphy and a local MRI.

Summary

The disease (Ewing’s sarcoma) got its name from the first description by James Ewing in 1921. These are highly malignant tumors that develop from degenerated primitive neuroectodermal cells (= immature precursor cells of nerve cells). Thus, Ewing sarcomas belong to the primitive, malignant, solid tumors.

As already mentioned above, Ewing’s sarcomas mainly affect the central areas of the long tubular bones and the pelvis, but it is also possible that the upper arm (= humerus) or the ribs are affected, so that parallel to the osteosarcoma, there are also parallel areas. Due to the accompanying signs of inflammation, confusion with osteomyelitis is conceivable. Due to metastases that occur very quickly (approx.

1⁄4 of all patients already show so-called daughter metastases at diagnosis), Ewing sarcomas can be found in soft tissue similar to rhabdomyosarcoma. The lungs are usually the most severely affected by metastasis. The causes that could be responsible for the development of Ewing sarcoma are still unknown.

However, it is currently assumed that neither the genetic component (heredity) nor an already performed radiotherapy can be held responsible for the development. However, it has been found that Ewing’s sarcoma often occurs when there are skeletal anomalies in the family or when patients suffer from a retinoblastoma (= malignant retinal tumor occurring in adolescence) from birth. Research has shown that tumor cells of the so-called family of Ewing’s sarcoma show a change on chromosome no.

22. It is assumed that this mutation (genetic change) is present in about 95% of all patients. Ewing sarcomas can cause swelling and pain in the affected region(s), which may also be associated with functional limitations.

Fever and moderate leukocytosis (= increase in the number of leukocytes in the blood) are also conceivable. Due to the possibility of confusion with, for example, osteomyelites (see above), a diagnosis is not always easy and may therefore require a biopsy (=fine tissue examination of a tissue sample) in addition to the imaging procedures (X-ray examination). Therapeutic approaches are usually applied on several levels.

On the one hand, the so-called therapy plan preoperatively usually provides for chemotherapeutic treatment (= neoadjuvant chemotherapy). Even after the surgical removal of the Ewing sarcoma, the patient will be treated therapeutically with radiation therapy and, if necessary, renewed chemotherapy.This is where a difference to osteosarcoma becomes noticeable: Compared to the Ewing sarcoma, the osteosarcoma has a lower radiation sensitivity. Whether or not recurrences (renewed tumor growth) occur depends strongly on the extent of metastasis formation, the response to preoperative chemotherapy and the “radicality” of tumor removal. It is currently assumed that the five-year survival probability is about 50%. In particular, surgical improvements over the last 25 years have made it possible to improve the probability of survival