First-Line Treatment of Ewing’s Sarcoma
Clinical Scenario
This protocol covers first-line management of Ewing’s sarcoma at initial presentation, guiding the multimodal treatment sequence from induction through to local tumour control and consolidation.
Treatment Approach
First-line management involves a multi-agent induction chemotherapy regimen, followed by local therapy directed at the primary tumour site and subsequent consolidation chemotherapy — the complete regimen, local therapy selection criteria, and full decision algorithm are contained in the structured protocol.
Treatment Goals
- Complete histological tumour response — 100% necrosis, fibrosis, and calcification — on surgical specimen assessment
- Reduction in the size of the soft-tissue mass on MRI
References
DOI: 10.1016/j.annonc.2021.08.1995
- Multiagent regimens including vincristine (V), doxorubicin (D), cyclophosphamide (C)/ifosfamide (I) and etoposide (E) have proven activity in ES in large collaborative trials.
- The interval-compressed VDC/IE regimen showed superiority to VIDE for both event-free survival and OS, with similar toxicity, and it is currently the preferred first-line treatment in ES [I, B].
- Complete surgical excision, where feasible, is regarded as the best modality of local control, given the higher risk of LR when RT is used as the sole treatment [IV, A].
- Recent studies suggest that 100% response is most optimal to define a good tumour response in ES.
- Change in the size of the soft tissue mass is easily evaluated on MRI, a good predictor of tumour response.
View source ↗