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The treatment plan has two main goals: (1) to cure the cancer, and (2) to save as much function of the affected area as possible. Patients with Ewing's sarcoma receive a combination of cancer-fighting drugs (chemotherapy) as well as surgery or radiation. Oncologists prescribe chemotherapy to control the spread of the disease to other bones or locations in the body and to shrink the existing tumor. Surgery or radiation typically is scheduled 2 to 4 months after chemotherapy begins.
The decision to use radiation, surgery or both can be difficult, and the choice varies from individual to individual. Mayo Clinic specialists provide advice and counseling to help the patient make an informed decision that will achieve the best overall outcome. Following surgery or radiation, physicians typically recommend additional chemotherapy to eliminate any remaining cancer cells.
Clinical trials sometimes offer a patient the best chance for successful treatment. Patients may be offered the opportunity to participate in available clinical trials that are suitable for their medical situation.
Mayo Clinic efficiently coordinates the many specialist activities required for diagnosis and successful treatment of Ewing's sarcoma. Whenever possible, treatment includes a state-of-the-art chemotherapy plan designed to minimize travel and time spent at the clinic. The Mayo team also designs outpatient chemotherapy treatment plans for Ewing's sarcoma patients who wish to receive therapy from a pediatric oncologist near their home.
In about 80 percent of Ewing's sarcoma cases involving an arm or leg, the limb can be saved. The possibility of saving the limb depends on the tumor's size and location; whether it has grown into or around a joint, nerves, or blood vessels; and its response to chemotherapy.
Options at Mayo Clinic include rotationplasty, bone grafts (autografts and allografts) and prosthetic implants.
In this procedure a surgeon harvests the patient's own bone tissue to implant at the site where cancerous tissue is removed. One common form of this procedure is called free vascularized fibular grafting. In this procedure surgeons harvest the smaller of the two lower leg bones as well as its blood vessels to implant at the cancer site. Currently Mayo Clinic surgeons have used the fibula to replace the upper leg bone, the upper arm bone, the lower leg bone and the jaw. Benefits of this procedure over allograft (bone graft from a donor) techniques include a greater chance for the bone to heal and a reduced chance for infection.
Orthopedic oncologists can use bone, tendons and ligaments from a tissue bank to rebuild areas where a patient experiences an Ewing's sarcoma tumor. This is called an allograft procedure. Surgeons at Mayo Clinic have significant experience using the procedure to replace joints (osteoarticular allograft) or other portions of the musculoskeletal system.
This procedure is typically used for young or athletic patients who have Ewing's sarcoma near the knee joint. Rotationplasty can allow a patient to run or walk with near-normal function. During the procedure, an orthopedic surgeon removes the tumor by cutting above and below the knee. The lower portion of the leg is rotated and reattached so that the ankle "becomes" the knee. Specialists then fit the patient with a prosthetic ankle and foot.
Surgeons can replace sections of bone with specialized prosthetic implants. Expandable and solid implants of many different sizes are available. Surgeons consider whether the patient will experience further bone growth before recommending prosthetic implants.
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