Therapy | Ewing sarcoma

Therapy

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 is 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.

Therapeutic goals: A so-called curative (healing) therapy approach is particularly given for patients whose Ewing sarcoma is localized and does not have any metastases. Meanwhile, the so-called neoadjuvant chemotherapy in combination with surgery and radiation therapy opens up further opportunities. If the Ewing sarcoma metastasizes outside the lung (= generalized tumor disease; extrapulmonary metastases), the therapy usually has a palliative (life-prolonging) character (see below).

Therapy modalities:local:

  • Preoperative chemotherapy
  • Surgical therapy (wide or radical resection after Enneking)
  • Radiotherapy

Systemic:antineoplastic chemotherapy Curative therapy: Palliative (life-prolonging) therapy:Patients who have a generalized tumor disease (= extrapulmonary metastases), the primary tumor is located at the trunk of the body and/or the primary tumor proves to be inoperable. In such cases, only palliative therapy is usually possible. In such cases, the focus is usually on maintaining the quality of life, so that the therapy focuses on pain relief and preservation of function.

  • Combination therapy (first line: doxorubicin, ifosfamide, methotrexate leukovorin, cisplatin; second line: etoposide and carboplatin) (protocols may change at short notice)
  • Aggressive multi-substance chemotherapy pre- and postoperatively
  • Local treatment in the form of surgical tumor resection or radiation alone
  • Supplementation of therapy by pre-irradiation (e.g. for inoperable tumors, non-responders) or by post-irradiation
  • It is important to mention in the context of surgical therapy that not least due to the further development of surgical methods, limb preserving procedures are possible in many cases. However, the prospect of healing always has the highest priority, so that the focus should always be on radicality (= oncological quality) and not on possible loss of function.
  • Subsequently, chemotherapy can be continued (see above). In this case, one speaks of a so-called consolidation.
  • Patients with pulmonary metastases may require additional interventions in the lung area, such as partial removal of the lungs.