This protocol addresses patients with Ewing's sarcoma who have undergone VIDE induction chemotherapy and show either an inadequate histological response or present with a large tumour volume exceeding 200 ml — two criteria that define a higher-risk sub-population with a specific, evidence-based escalation strategy.
Clinical scenario: The patient has a history of chemotherapy (VIDE induction) and meets one or both of the following conditions:
For patients in this scenario, management involves local tumour control followed by high-dose consolidation chemotherapy with autologous blood stem cell rescue — an approach with randomised trial support in Ewing's sarcoma.
The complete sequencing, decision criteria, and all further details of local control and consolidation are available in the full structured protocol.The results of randomised studies with busulfan and melphalan (BuMel) indicated that this approach results in a survival advantage for patients with poor response to VIDE induction ChT and/or tumour volume >200 ml [II, A].
The use of high-dose ChT with escalated alkylating agent dose and autologous blood stem cell rescue has attracted much attention in ES since the 1970s.
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.
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