CHEMOTHERAPY Chemotherapy includes several medicines that kill cancer cells, shrink tumors, and prevent cancer cells from spreading. Ewing sarcoma can spread early in your child’s illness, making chemotherapy an important part of your child’s treatment. Several chemotherapy medications can kill the cells that cause Ewing sarcoma, but no single chemotherapy medicine alone can control the cancer. As a result, chemotherapy medications are usually given in combination. Each cycle of treatment usually lasts several days. The treatment may be given in the hospital, which requires an overnight stay, or in an outpatient clinic, which requires daily visits to the clinic. Your child’s healthcare team will discuss with you the specific chemotherapy medications your child will receive and how and when they will be given. Most medications are given through the veins or a VAD. Your child’s healthcare team also will explain the possible side effects of the specific chemotherapy treatment that your child will receive. SURGERY It is sometimes possible to remove the entire tumor by surgery at the time of diagnosis. More commonly, Ewing sarcoma requires a combination of chemotherapy and surgery, and possibly radiation therapy. Typically treatment starts with chemotherapy. Chemotherapy may shrink the size of the tumor, which helps to decrease the risk of surgical injury to the healthy tissues surrounding the tumor. When the surgeon removes the tumor, the goal is to take out the entire tumor with a small amount of healthy surrounding tissue, called the margin. This reduces the chance that the tumor will regrow in this area. Once the tumor is removed, a pathologist will look at it under a microscope to ensure that no tumor cells are at the edge of the margin. If tumors cells are seen at the margin, cells may have been left behind in your child’s body, and radiation therapy will likely be needed. Your medical team will discuss these results and decisions with you. If your child’s cancer is metastatic or if tumors are in certain difficult-to-access locations, surgery may not be an option. RADIATION Radiation therapy is a very precise kind of X-ray treatment. Radiation may be used alone or in combination with surgery, depending on the location of the Ewing sarcoma. It is given in carefully measured amounts by radiation therapy experts. If radiation is necessary for your child, the radiation therapy doctor will discuss with you exactly how the radiation will be given and how long the treatments will last. Radiation therapy is usually given once daily, Monday through Friday, for several weeks in a row. If your child is young or unable to stay still, daily sedation may be required to assist your child through the radiation experience. During radiation some children become more tired than usual or have decreased appetites or nausea. Irritation to the skin within the radiation field may occur. Other possible side effects will be discussed in detail with you and your child prior to the start of therapy. ARE THERE CONCERNS TO ADDRESS PRIOR TO INITIATING TREATMENT? Yes. Short- and long-term side effects may occur as a result of treatment. Therefore, before starting any chemotherapy, surgery, or radiation, it is important to obtain baseline information about your child’s health and organ function. Some potential long-term side effects include the following: • Damage to the muscle of the heart—Doxorubicin is a chemotherapy agent that may cause damage to the heart muscle. It is important to obtain a baseline echocardiogram to establish baseline function and to evaluate whether it is safe to proceed. Your child’s healthcare team should inform you about possible heart-protectant medications.
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