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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65912_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65912_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65912_"><span class="title" itemprop="name">Ewing Sarcoma Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Pediatric Treatment Editorial Board</span>.</p><p class="small">Published online: April 5, 2018.</p><p class="small">Created: <span itemprop="datePublished">December 14, 2007</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000403689__236">This PDQ cancer information summary has current information about the treatment of childhood Ewing sarcoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000403689__237">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.</p></div><div id="CDR0000403689__1"><h2 id="_CDR0000403689__1_">General Information About Ewing Sarcoma</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000403689__2">Ewing sarcoma is a type of tumor that forms in bone or soft tissue.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__14">Signs and symptoms of Ewing sarcoma include swelling and pain near the tumor. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__18">Tests that examine the bone and soft tissue are used to diagnose and stage Ewing sarcoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__155">A biopsy is done to diagnose Ewing sarcoma. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__22">Certain factors affect prognosis (chance of recovery).</a></div></li></ul></div><div id="CDR0000403689__2"><h3>Ewing sarcoma is a type of tumor that forms in bone or soft tissue.</h3><p id="CDR0000403689__4"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046031/" class="def">Ewing sarcoma</a> is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> that forms from a certain kind of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cell</a> in bone or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">soft tissue</a>. Ewing sarcoma may be found in the bones of the legs, arms, feet, hands, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044996/" class="def">chest</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000763008/" class="def">skull</a>. Ewing sarcoma also may be found in the soft tissue of the trunk, arms, legs, head and neck, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a>, or other areas.</p><p id="CDR0000403689__123">Ewing sarcoma is most common in adolescents and young adults.</p><p id="CDR0000403689__247">Ewing sarcoma has also been called peripheral primitive neuroectodermal tumor, Askin tumor (Ewing sarcoma of the chest wall), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476629/" class="def">extraosseous</a> Ewing sarcoma (Ewing sarcoma in tissue other than bone), and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322134/" class="def">Ewing sarcoma family of tumors</a>.</p></div><div id="CDR0000403689__14"><h3>Signs and symptoms of Ewing sarcoma include swelling and pain near the tumor. </h3><p id="CDR0000403689__16">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by Ewing sarcoma or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>.
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Check with your child’s doctor if your child has any of the following:
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</p><ul id="CDR0000403689__115"><li class="half_rhythm"><div>Pain and/or swelling, usually in the arms, legs, chest, back, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>.</div></li><li class="half_rhythm"><div>A lump (which may feel soft and warm) in the arms, legs, chest, or pelvis.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a> for no known reason.</div></li><li class="half_rhythm"><div>A bone that breaks for no known reason.</div></li></ul></div><div id="CDR0000403689__18"><h3>Tests that examine the bone and soft tissue are used to diagnose and stage Ewing sarcoma.</h3><p id="CDR0000403689__224">Procedures that make pictures of the bones and soft tissues and nearby areas help <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> Ewing sarcoma and show how far the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread. The process used to find out if cancer cells have spread within and around the bones and soft tissues is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>.</p><p id="CDR0000403689__225">In order to plan treatment, it is important to know if the cancer is in the area where it first formed or if it has spread to other parts of the body. Tests and procedures to detect, diagnose, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> Ewing sarcoma are usually done at the same time.</p><p id="CDR0000403689__20">The following tests and procedures may be used to diagnose or stage Ewing sarcoma:</p><ul id="CDR0000403689__21"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body, such as the area where the tumor formed. This procedure is also called nuclear magnetic resonance imaging (NMRI).<div id="CDR0000403689__242" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Magnetic%20resonance%20imaging%20(MRI)%20of%20the%20abdomen&p=BOOKS&id=493316_CDR0000775532.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65912.13/bin/CDR0000775532.jpg" alt="Magnetic resonance imaging (MRI) of the abdomen; drawing shows a child lying on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Magnetic resonance imaging (MRI) of the abdomen. The child lies on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, such as the area where the tumor formed or the chest, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.<div id="CDR0000403689__243" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Computed%20tomography%20(CT)%20scan%20of%20the%20abdomen&p=BOOKS&id=493316_CDR0000775531.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65912.13/bin/CDR0000775531.jpg" alt="Computed tomography (CT) scan of the abdomen; drawing shows a child lying on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Computed tomography (CT) scan of the abdomen. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a> tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> rotates around the body and makes a picture of where <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
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A PET scan and a CT scan are often done at the same time. If there is any <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>, this increases the chance that it will be found.<div id="CDR0000403689__244" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Positron%20emission%20tomography%20(PET)%20scan&p=BOOKS&id=493316_CDR0000775456.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65912.13/bin/CDR0000775456.jpg" alt="Positron emission tomography (PET) scan; drawing shows a child lying on table that slides through the PET scanner." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Positron emission tomography (PET) scan. The child lies on a table that slides through the PET scanner. The head rest and white strap help the child lie still. A small amount of radioactive glucose (sugar) is injected into the child's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do. </p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046499/" class="def">Bone scan</a></b>: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.<div id="CDR0000403689__245" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Bone%20scan&p=BOOKS&id=493316_CDR0000775451.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65912.13/bin/CDR0000775451.jpg" alt="Bone scan; drawing shows a child lying on a table that slides under the scanner, a technician operating the scanner, and a computer monitor that will show images made during the scan." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Bone scan. A small amount of radioactive material is injected into the child's vein and travels through the blood. The radioactive material collects in the bones. As the child lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046505/" class="def">Bone marrow aspiration</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046506/" class="def">biopsy</a></b>: The removal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> and a small piece of bone by inserting a hollow needle into the hipbone. Samples are removed from both hipbones. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the bone marrow and bone under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to see if the cancer has spread.<div id="CDR0000403689__246" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Bone%20marrow%20aspiration%20and%20biopsy&p=BOOKS&id=493316_CDR0000775458.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65912.13/bin/CDR0000775458.jpg" alt="Bone marrow aspiration and biopsy; drawing shows a child lying face down on a table and a bone marrow needle being inserted into the right hip bone. An inset shows the bone marrow needle being inserted through the skin into the bone marrow of the hip bone." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Bone marrow aspiration and biopsy. After a small area of skin is numbed, a bone marrow needle is inserted into the child’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.</p></div></div></div></li><li class="half_rhythm"><div><b>X-ray</b>: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body, such as the chest or the area where the tumor formed.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045107/" class="def">Complete blood count</a> (CBC)</b>: A procedure in which a sample of blood is drawn and checked for the following:<dl id="CDR0000403689__144" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">The number of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cells</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelets</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">The amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045108/" class="def">hemoglobin</a> (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> that carries <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a>) in the red blood cells.</p></dd><dt>-</dt><dd><p class="no_top_margin">The portion of the blood sample made up of red blood cells.
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</p></dd></dl></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry studies</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354462/" class="def">lactate dehydrogenase</a> (LDH), released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
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</div></li></ul></div><div id="CDR0000403689__155"><h3>A biopsy is done to diagnose Ewing sarcoma. </h3><p id="CDR0000403689__203">Tissue samples are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. It is helpful if the biopsy is done at the same center where treatment will be given.</p><ul id="CDR0000403689__204"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045798/" class="def">Needle biopsy</a></b>: For a needle biopsy, tissue is removed using a needle. This type of needle biopsy may be done if it’s possible to remove tissue samples large enough to be used for testing.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046698/" class="def">Incisional biopsy</a></b>: For an incisional biopsy, a sample of tissue is removed through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incision</a> in the skin. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046411/" class="def">Excisional biopsy</a></b>: The removal of an entire lump or area of tissue that doesn’t look normal.</div></li></ul><p id="CDR0000403689__210">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a> (pathologist, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">radiation oncologist</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044306/" class="def">surgeon</a>) who will treat the patient usually work together to decide where the needle should be placed or the biopsy incision should be made. This is done so that the biopsy doesn't affect later treatment such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the tumor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</p><p id="CDR0000403689__205">If there is a chance that the cancer has spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, one or more lymph nodes may be removed and checked for signs of cancer.</p><p id="CDR0000403689__147">The following tests may be done on the tissue that is removed:</p><ul id="CDR0000403689__148"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270737/" class="def">Cytogenetic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390238/" class="def">analysis</a></b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosomes</a>.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000653117/" class="def">Immunohistochemistry</a></b>: A test that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to check for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335066/" class="def">Flow cytometry</a></b>: A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of cells, such as size, shape, and the presence of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">tumor markers</a> on the cell surface. The cells are stained with a light-sensitive dye, placed in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a>, and passed in a stream before a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045748/" class="def">laser</a> or other type of light. The measurements are based on how the light-sensitive dye reacts to the light. </div></li></ul></div><div id="CDR0000403689__22"><h3>Certain factors affect prognosis (chance of recovery).</h3><p id="CDR0000403689__24">The factors that affect <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) are different before and after treatment. </p><p id="CDR0000403689__152">Before treatment, prognosis depends on:</p><ul id="CDR0000403689__128"><li class="half_rhythm"><div>Whether the tumor has spread to lymph nodes or distant parts of the body. </div></li><li class="half_rhythm"><div>Where in the body the tumor started.</div></li><li class="half_rhythm"><div>Whether the tumor formed in the bone or in soft tissue.</div></li><li class="half_rhythm"><div>How large the tumor is at when the tumor is diagnosed.</div></li><li class="half_rhythm"><div>Whether the LDH level in the blood is higher than normal.</div></li><li class="half_rhythm"><div>Whether the tumor has certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a> changes. </div></li><li class="half_rhythm"><div>Whether the child is younger than 15 years. </div></li><li class="half_rhythm"><div>The patient's sex. </div></li><li class="half_rhythm"><div>Whether the child has had treatment for a different cancer before Ewing sarcoma.</div></li><li class="half_rhythm"><div>Whether the tumor has just been diagnosed or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back).</div></li></ul><p id="CDR0000403689__149">After treatment, prognosis is affected by:</p><ul id="CDR0000403689__150"><li class="half_rhythm"><div>Whether the tumor was completely removed by surgery.</div></li><li class="half_rhythm"><div>Whether the tumor responds to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>.</div></li></ul><p id="CDR0000403689__226">If the cancer recurs after initial treatment, prognosis depends on:</p><ul id="CDR0000403689__227"><li class="half_rhythm"><div>Whether the cancer came back more than two years after the initial treatment.</div></li><li class="half_rhythm"><div>Where in the body the tumor came back.</div></li><li class="half_rhythm"><div>The type of initial treatment given.</div></li></ul></div></div><div id="CDR0000403689__28"><h2 id="_CDR0000403689__28_">Stages of Ewing Sarcoma</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000403689__29">The results of diagnostic and staging tests are used to find out if cancer cells have spread.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__106">Ewing sarcoma is described based on whether the cancer has spread from the bone or soft tissue in which the cancer began. </a></div><ul><li class="half_rhythm"><div><a href="#CDR0000403689__108">Localized Ewing sarcoma</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__111">Metastatic Ewing sarcoma</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000403689__157">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__207">Cancer may spread from where it began to other parts of the body.</a></div></li></ul></div><div id="CDR0000403689__29"><h3>The results of diagnostic and staging tests are used to find out if cancer cells have spread.</h3><p id="CDR0000403689__31">The process used to find out if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread from where it began to other parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. There is no standard <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689095/" class="def">staging system</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046031/" class="def">Ewing sarcoma</a>. The results of the <a href="#CDR0000403689__18">tests and procedures</a> done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> Ewing sarcoma are used to group the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> into <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045754/" class="def">localized</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a>. </p></div><div id="CDR0000403689__106"><h3>Ewing sarcoma is described based on whether the cancer has spread from the bone or soft tissue in which the cancer began. </h3><p id="CDR0000403689__129">Ewing sarcoma is described as either localized or metastatic.
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</p><div id="CDR0000403689__108"><h4>Localized Ewing sarcoma</h4><p id="CDR0000403689__110">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is found in the bone or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">soft tissue</a> in which it began and may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, including nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.</p></div><div id="CDR0000403689__111"><h4>Metastatic Ewing sarcoma</h4><p id="CDR0000403689__113">
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The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread from the bone or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">soft tissue</a> in which it began to other parts of the body. In Ewing tumor of bone, the cancer most often spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, other bones, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>. </p></div></div><div id="CDR0000403689__157"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000403689__157_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000403689__157_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000403689__207"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000403689__207_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000403689__207_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000403689__209">The metastatic tumor is the same type of cancer as the primary tumor. For example, if Ewing sarcoma spreads to the lung, the cancer cells in the lung are actually Ewing sarcoma cells. The disease is metastatic Ewing sarcoma, not lung cancer.</p><div id="CDR0000403689__256" class="box"><h3><span class="title">metastasis: how cancer spreads</span></h3><div class="caption"><p>Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.</p></div><p><a href="https://www.youtube.com/watch?v=fQwar_-QdiQ" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div></div><div id="CDR0000403689__45"><h2 id="_CDR0000403689__45_">Recurrent Ewing Sarcoma</h2><p id="CDR0000403689__46"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046031/" class="def">Ewing sarcoma</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back) after it has been treated. The cancer may come back in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> where it first started or in another part of the body. </p></div><div id="CDR0000403689__47"><h2 id="_CDR0000403689__47_">Treatment Option Overview</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000403689__48">There are different types of treatment for children with Ewing sarcoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__52">Children with Ewing sarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__118">Treatment for Ewing sarcoma may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__56">Five types of standard treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000403689__65">Chemotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__62">Radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__206">Surgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__228">Targeted therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__233">High-dose chemotherapy with stem cell rescue</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000403689__80">New types of treatment are being tested in clinical trials. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__159">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__161">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000403689__163">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000403689__48"><h3>There are different types of treatment for children with Ewing sarcoma.</h3><p id="CDR0000403689__50">Different types of treatments are available for children with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046031/" class="def">Ewing sarcoma</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346525/" class="def">standard</a> (the currently used treatment), and some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current treatments or obtain information on new treatments for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.</p><p id="CDR0000403689__51">Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.</p></div><div id="CDR0000403689__52"><h3>Children with Ewing sarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children.</h3><p id="CDR0000403689__54">Treatment will be overseen by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693555/" class="def">pediatric oncologist</a>, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000650566/" class="def">health care providers</a> who are experts in treating children with Ewing sarcoma and who specialize in certain areas of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a>. These may include the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a>:</p><ul id="CDR0000403689__55"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000757278/" class="def">Pediatrician</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044735/" class="def">Surgical oncologist</a> or orthopedic <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046260/" class="def">oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">Radiation oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318821/" class="def">Pediatric nurse specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044730/" class="def">Social worker</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318825/" class="def">Rehabilitation specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044716/" class="def">Psychologist</a>. </div></li></ul></div><div id="CDR0000403689__118"><h3>Treatment for Ewing sarcoma may cause side effects.</h3><p id="CDR0000403689__118_76">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> that begin during treatment for cancer, see our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p><p id="CDR0000403689__120">
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Side effects from cancer treatment that begin after treatment and continue for months or years are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>. Late effects of cancer treatment may include the following:
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</p><ul id="CDR0000403689__130"><li class="half_rhythm"><div>Physical problems.</div></li><li class="half_rhythm"><div>Changes in mood, feelings, thinking, learning, or memory.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">Second cancers</a> (new types of cancer). Patients treated for Ewing sarcoma have an increased risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046347/" class="def">acute myeloid leukemia</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045266/" class="def">myelodysplastic syndrome</a>. There is also an increased risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045562/" class="def">sarcoma</a> in the area treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li></ul><p id="CDR0000403689__131">Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a> for more information.)
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</p></div><div id="CDR0000403689__56"><h3>Five types of standard treatment are used:</h3><div id="CDR0000403689__65"><h4>Chemotherapy</h4><p id="CDR0000403689__151"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a>, an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> is treatment using more than one anticancer drug.</p><p id="CDR0000403689__199">Systemic chemotherapy is part of the treatment for all patients with Ewing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>. It is often the first treatment given and lasts for about 6 to 12 months. Chemotherapy is often given to shrink the tumor before <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> or radiation therapy and to kill any tumor cells that may have spread to other parts of the body.</p><p id="CDR0000403689__250">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/soft-tissue-sarcoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Soft Tissue Sarcoma</a> for more information.</p></div><div id="CDR0000403689__62"><h4>Radiation therapy</h4><p id="CDR0000403689__64">Radiation therapy is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are two types of radiation therapy:</p><ul id="CDR0000403689__251"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000403689__191">External radiation therapy is used to treat Ewing sarcoma.</p><p id="CDR0000403689__200">Radiation therapy is used when the tumor cannot be removed by surgery or when surgery to remove the tumor will affect important body functions or the way the child will look. It may be used to make the tumor smaller and decrease the amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that needs to be removed during surgery. It may also be used to treat any tumor that remains after surgery and tumors that have spread to other parts of the body.</p></div><div id="CDR0000403689__206"><h4>Surgery</h4><p id="CDR0000403689__193">Surgery is usually done to remove cancer that is left after chemotherapy or radiation therapy. When possible, the whole tumor is removed by surgery. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">Tissue</a> and bone that are removed may be replaced with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046373/" class="def">graft</a>, which uses tissue and bone taken from another part of the patient's body or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a>. Sometimes an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285636/" class="def">implant</a>, such as artificial bone, is used.</p><p id="CDR0000403689__194">Even if the doctor removes all of the cancer that can be seen at the time of the operation, chemotherapy or radiation therapy may be given after surgery to kill any cancer cells that are left. Chemotherapy or radiation therapy given after surgery to lower the risk that the cancer will come back is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant therapy</a>.
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</p></div><div id="CDR0000403689__228"><h4>Targeted therapy</h4><p id="CDR0000403689__230"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.</p><p id="CDR0000403689__231"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibody</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> is a type of targeted therapy used in the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> Ewing sarcoma. It is being studied for the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> Ewing sarcoma. Monoclonal antibodies are made in the laboratory from a single type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. They may be used alone or to carry drugs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046622/" class="def">toxins</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> material directly to cancer cells. </p><p id="CDR0000403689__248">New types of targeted therapy are being studied.</p><ul id="CDR0000403689__249"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750798/" class="def">Kinase inhibitor</a> therapy is a type of targeted therapy. Kinase inhibitors are drugs that block a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> needed for cancer cells to divide. They are being studied in the treatment of recurrent Ewing sarcoma. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000660869/" class="def">PARP inhibitor</a> therapy is a type of targeted therapy. PARP inhibitors are drugs that block <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> repair and may cause cancer cells to die. They are being studied in the treatment of recurrent Ewing sarcoma.</div></li><li class="half_rhythm"><div>NEDD8-activating enzyme (NAE) inhibitor therapy is a type of targeted therapy. NAE inhibitors are drugs that attach to NAE and stop the cancer cells from dividing. This targeted therapy is being studied in the treatment of recurrent Ewing sarcoma.</div></li></ul></div><div id="CDR0000403689__233"><h4>High-dose chemotherapy with stem cell rescue</h4><p id="CDR0000403689__235"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">High-dose chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666718/" class="def">stem cell rescue</a> is a way of giving high <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of chemotherapy to treat Ewing sarcoma and then replacing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>-forming cells destroyed by cancer treatment. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">Stem cells</a> (immature blood cells) are removed from the blood or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> of the patient and are frozen and stored. After chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Chemotherapy with stem cell rescue is used to treat recurrent Ewing sarcoma.</p></div></div><div id="CDR0000403689__80"><h3>New types of treatment are being tested in clinical trials. </h3><p id="CDR0000403689__156">This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000403689__218"><h4>Chimeric antigen receptor (CAR) T-cell therapy</h4><p id="CDR0000403689__220"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000771302/" class="def">CAR T-cell therapy</a> is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> that changes the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T cells</a> (a type of immune system cell) so they will attack certain proteins on the surface of cancer cells. T cells are taken from the patient and special <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044958/" class="def">receptors</a> are added to their surface in the laboratory. The changed cells are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000613507/" class="def">chimeric</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigen</a> receptor (CAR) T cells. The CAR T cells are grown in the laboratory and given to the patient by infusion. The CAR T cells multiply in the patient's blood and attack cancer cells. CAR T-cell therapy is being studied in the treatment of Ewing sarcoma that has recurred.</p><div id="CDR0000403689__257" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=CAR%20T-cell%20therapy&p=BOOKS&id=493316_CDR0000774647.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65912.13/bin/CDR0000774647.jpg" alt="CAR T-cell therapy; drawing of blood being removed from a vein in a patient’s arm to get T cells. Also shown is a special receptor called a chimeric antigen receptor (CAR) being made in the laboratory; the gene for CAR is inserted into the T cells and then millions of CAR T cells are grown. Drawing also shows the CAR T cells being given to the patient by infusion and binding to antigens on the cancer cells and killing them." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>CAR T-cell therapy. A type of treatment in which a patient’s T cells (a type of immune cell) are changed in the laboratory so they will bind to cancer cells and kill them. Blood from a vein in the patient’s arm flows through a tube to an apheresis machine (not shown), which removes the white blood cells, including the T cells, and sends the rest of the blood back to the patient. Then, the gene for a special receptor called a chimeric antigen receptor (CAR) is inserted into the T cells in the laboratory. Millions of the CAR T cells are grown in the laboratory and then given to the patient by infusion. The CAR T cells are able to bind to an antigen on the cancer cells and kill them.</p></div></div></div></div><div id="CDR0000403689__159"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000403689__159_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000403689__159_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000403689__159_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000403689__161"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000403689__161_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000403689__161_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000403689__163"><h3>Follow-up tests may be needed.</h3><p id="CDR0000403689__163_55">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000403689__163_56">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p></div></div><div id="CDR0000403689__90"><h2 id="_CDR0000403689__90_">Treatment Options for Ewing Sarcoma</h2><p id="CDR0000403689__254">For information about the treatments listed below, see the <a href="#CDR0000403689__56">Treatment Option Overview</a> section.</p><div id="CDR0000403689__91"><h3>Localized Ewing Sarcoma </h3><p id="CDR0000403689__213"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatments</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045754/" class="def">localized</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046031/" class="def">Ewing sarcoma</a> include:</p><ul id="CDR0000403689__214"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li></ul><p id="CDR0000403689__195"> These treatments and the order they are given depend on the following:</p><ul id="CDR0000403689__201"><li class="half_rhythm"><div>Where in the body the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> started.</div></li><li class="half_rhythm"><div>How large the tumor is when the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a>.</div></li><li class="half_rhythm"><div>Whether the tumor was completely removed by surgery.</div></li><li class="half_rhythm"><div>The child's age and general health.</div></li><li class="half_rhythm"><div>Whether the treatment will affect important body functions or the way the child will look. </div></li></ul><p id="CDR0000403689__215">Treatments being studied for localized Ewing sarcoma include:</p><ul id="CDR0000403689__216"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">High-dose chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666718/" class="def">stem cell rescue</a>.</div></li></ul><p id="CDR0000403689__TrialSearch_91_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000403689__95"><h3>Metastatic Ewing Sarcoma</h3><p id="CDR0000403689__221"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatments</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046031/" class="def">Ewing sarcoma</a> include: </p><ul id="CDR0000403689__222"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a>.</div></li></ul><p id="CDR0000403689__197">These treatments and the order they are given depend on the following: </p><ul id="CDR0000403689__202"><li class="half_rhythm"><div>Where in the body the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> started.</div></li><li class="half_rhythm"><div>Where the tumor has spread.</div></li><li class="half_rhythm"><div>How large the tumor is.</div></li><li class="half_rhythm"><div>Whether the treatment will affect important body functions or the way the child will look.</div></li><li class="half_rhythm"><div>The child's age and general health.</div></li></ul><p id="CDR0000403689__211">Treatments being studied for metastatic Ewing sarcoma include the following:</p><ul id="CDR0000403689__212"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a>. Radiation therapy is given to areas of bone where cancer has spread.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">High-dose chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666718/" class="def">stem cell rescue</a>.</div></li></ul><p id="CDR0000403689__TrialSearch_95_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000403689__99"><h3>Recurrent Ewing Sarcoma</h3><p id="CDR0000403689__223">There is no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046031/" class="def">Ewing sarcoma</a> but treatment options may include the following:</p><ul id="CDR0000403689__101"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> to bone <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>, as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a> to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</div></li><li class="half_rhythm"><div> Radiation therapy that may be followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove tumors that have spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">High-dose chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666718/" class="def">stem cell rescue</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a> with or without a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">tyrosine kinase inhibitor</a>. </div></li></ul><p id="CDR0000403689__238">These treatments and the order they are given depend on the following:</p><ul id="CDR0000403689__239"><li class="half_rhythm"><div>Where in the body the tumor came back.</div></li><li class="half_rhythm"><div>The initial treatment given.</div></li></ul><p id="CDR0000403689__240">Treatment options being studied for recurrent Ewing sarcoma include the following:</p><ul id="CDR0000403689__241"><li class="half_rhythm"><div>Checking a sample of the patient's tumor for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a> changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.</div></li><li class="half_rhythm"><div>Targeted therapy with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">tyrosine kinase inhibitor</a>. </div></li><li class="half_rhythm"><div>Targeted therapy with a monoclonal antibody. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000771301/" class="def">Chimeric antigen receptor (CAR) T-cell therapy</a>.</div></li><li class="half_rhythm"><div>Targeted therapy with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000660869/" class="def">PARP inhibitor</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div>Targeted therapy with NEDD8-activating enzyme inhibitor therapy and chemotherapy. </div></li></ul><p id="CDR0000403689__TrialSearch_99_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000403689__142"><h2 id="_CDR0000403689__142_">To Learn More About Ewing Sarcoma</h2><p id="CDR0000403689__143">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about Ewing sarcoma, see the following:</p><ul id="CDR0000403689__180"><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/bone" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Bone Cancer Home Page</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/ct-scans-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Computed Tomography (CT) Scans and Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Cancer Therapies</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/bone/bone-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Bone Cancer</a></div></li></ul><p id="CDR0000403689__142_44">For more childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other general cancer resources, see the following:</p><ul id="CDR0000403689__142_45"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Childhood Cancers</a>
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</div></li><li class="half_rhythm"><div><a href="http://www.curesearch.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CureSearch for Children's Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/aya" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Adolescents and Young Adults with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/guide-for-parents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Children with Cancer: A Guide for Parents</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer in Children and Adolescents</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000403689__AboutThis_1"><h2 id="_CDR0000403689__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000403689__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000403689__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000403689__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000403689__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000403689__AboutThis_6">This PDQ cancer information summary has current information about the treatment of childhood Ewing sarcoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000403689__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000403689__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
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</p><p id="CDR0000403689__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>.
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</p></div><div id="CDR0000403689__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000403689__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000403689__AboutThis_12">Clinical trials are listed in PDQ and can be found online at <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000403689__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000403689__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000403689__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000403689__AboutThis_21">PDQ® Pediatric Treatment Editorial Board. PDQ Ewing Sarcoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/bone/patient/ewing-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/bone/patient/ewing-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389350]</p><p id="CDR0000403689__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 scientific images.
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</p></div><div id="CDR0000403689__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000403689__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000403689__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000403689__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65912.13/?report=reader">PubReader</a></li><li><a href="/books/NBK65912.13/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65912" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65912" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Pediatric Treatment Editorial Board. Ewing Sarcoma Treatment (PDQ®): Patient Version. 2018 Apr 5. In: PDQ Cancer Information Summaries [Internet]. 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class="bk_col_itm"><a href="/books/NBK65912.6/">NBK65912.6</a></span> October 3, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65912.5/">NBK65912.5</a></span> May 18, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65912.4/">NBK65912.4</a></span> October 30, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65912.3/">NBK65912.3</a></span> October 14, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65912.2/">NBK65912.2</a></span> October 9, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65912.1/">NBK65912.1</a></span> January 29, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000403689__1" ref="log$=inpage&link_id=inpage">General Information About Ewing Sarcoma</a></li><li><a href="#CDR0000403689__28" ref="log$=inpage&link_id=inpage">Stages of Ewing Sarcoma</a></li><li><a href="#CDR0000403689__45" ref="log$=inpage&link_id=inpage">Recurrent Ewing Sarcoma</a></li><li><a href="#CDR0000403689__47" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000403689__90" ref="log$=inpage&link_id=inpage">Treatment Options for Ewing Sarcoma</a></li><li><a href="#CDR0000403689__142" ref="log$=inpage&link_id=inpage">To Learn More About Ewing Sarcoma</a></li><li><a href="#CDR0000403689__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK66045/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389379" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Uterine Sarcoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Uterine Sarcoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389178" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Kaposi Sarcoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Kaposi Sarcoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389216" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" 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ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Melanoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Melanoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li></ul><a class="seemore" 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