Almost all children treated for Ewing sarcoma are treated with a combination of chemotherapy and surgery and/or radiation. Aggressive treatment is common in Ewing sarcoma because of the incidence and risk of metastasis.
Chemotherapy is often the first course of treatment for Ewing sarcoma. Unlike other cancers, where surgery might be the first step, doctors often use chemotherapy to reduce the size of the tumor before removing it surgically. Ewing sarcoma patients are often treated with combination therapy, which means that several different chemotherapy agents are used simultaneously. Chemotherapy is also used after surgery to eradicate any remaining cancer cells.
After chemotherapy has reduced the cancer, surgery is likely to be more effective for treating Ewing sarcoma. At this point, most of the time surgeons will remove the tumor if possible. In some cases, children will need grafts of bone or tissue, or artificial bone, to replace diseased areas that must be removed. Very rarely, amputation is required to fully remove a tumor.
Radiation can also be used in combination with chemotherapy and surgery to kill cancer cells that surgery cannot remove. It will be used instead or before surgery in tumors that cannot be removed, or after surgery if the patient has had the tumor removed but there are “close margins” – meaning the tumor is close to edge of the surgical resection.