Ewing Sarcoma

Ewing Sarcoma Treatment

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 sarcoma receive a combination of cancer-fighting drugs (chemotherapy) and 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 tumor. Surgery or radiation typically is scheduled two to four months after chemotherapy begins.

The decision to use radiation, surgery or both can be difficult, and the choice varies among patients. 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 an improved chance for successful treatment. Patients may be offered the opportunity to participate in a clinical trial, if appropriate that are suitable for their medical situation.

Mayo Clinic efficiently coordinates the involvement of specialists required for diagnosis and successful treatment of Ewing sarcoma. Whenever possible, treatment includes a state-of-the-art chemotherapy plan designed to minimize travel and time spent at the clinic.

In about 80 percent of Ewing 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.

Limb Salvage Techniques

Options at Mayo Clinic include rotationplasty, bone grafts (autografts and allografts) and prosthetic implants.

Autograft (bone graft from a patient's own tissue)

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 and its blood vessels to implant at the cancer site. 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) include a greater chance for the bone to heal and a reduced chance for infection.

Allograft (bone graft from a donor's tissue)

Orthopedic oncologists can use bone, tendons and ligaments from a tissue bank to rebuild areas where a patient has a Ewing sarcoma tumor. This procedure is called an allograft. Surgeons at Mayo Clinic have significant experience using the procedure to replace joints (osteoarticular allograft) or other portions of the musculoskeletal system.

Rotationplasty

This procedure is typically used for young or athletic patients who have Ewing 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.

Prosthetic Implants

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.