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Ewing’s sarcoma is a rare type of cancer that occurs in children and adolescents aged 10 to 19 years. It usually grows in bone but can also affect soft tissue (tendons, ligaments, cartilage or muscles). The exact cause of the disease is unknown.
Before the discovery of systemic therapy, 90% of cancer patients developed metastases, which little chance for a favorable outcome. The development of modern medicine allowed patients to resist illness. To find out about available methods of juvenile Ewing’s sarcoma and what countries provide it – read our article.
HOW DOES EWING SARCOMA MANIFEST ITSELF IN KIDS?
The symptoms of Ewing’s sarcoma are different for every child. The first signs are similar to other diseases. Parents need to be wary and consult a doctor if the child has any problems:
pain in the area of neoplasm that comes but and goes, but increases with time and activity;
swelling around the tumor site;
lump under the skin;
fever;
limping, if the tumor is in the leg;
frequent bone fracturing for no apparent reason;
weight loss;
constant tiredness;
significant growth in regional lymph nodes.
X-rays and other visual tests can diagnose Ewing’s sarcoma. A biopsy is also needed to make an accurate diagnosis. If the doctors confirm the diagnosis, constant care during and after treatment is detrimental to the treatment outcome.
MAIN METHODS OF TREATMENT FOR EWING’S SARCOMA
The treatment scheme depends on the stage of the illness, localization of the malignancy, coexistent pathologies, age and general condition of the child. To increase the efficiency of cancer therapy, doctors use a comprehensive approach, combining several methods (such as surgery, chemotherapy, and radiotherapy) in a single program.
LOCALIZED EWING’S SARCOMA TREATMENT OPTIONS
For localized Ewing’s sarcoma, the main course of treatment is neoadjuvant chemotherapy. The treatment period is usually 8-12 weeks.
Following the chemo, oncologists apply visual examinations, such as MRI and CT, to assess cancer’s condition and make a further treatment scheme.
If the neoplasm hasn’t grown (or shrunk in size), it can be surgically removed. In doing so, the surgeon removes the maximum volume of the tumor, as well as the edge of the neighboring tissue. If the resected sample does not contain malignant cells, doctors proceed with adjuvant chemotherapy.
If the doctors detect any cancerous cells, they proceed with combining radiation therapy and chemotherapy. This treatment takes approximately 24 weeks. Doctors then carry out extensive full-body examination and make a further treatment plan or a relapse-prevention scheme.
CHEMOTHERAPY
Patients undergo chemotherapy in cycles, taking time to get proper rest. Usually, children are treated with a combination of drugs.
SURGERY
After chemotherapy or sometimes radiation therapy, doctors perform a surgical intervention, removing the tumor. Modern methods allow for limb-preserving surgery.
RADIATION THERAPY
If surgery is not applicable, doctors apply radiation therapy. It is also indicated for the eradication of residual cancerous cells or if a neoplasm cannot be fully resected.
TREATMENT OF METASTATIC EWING’S SARCOMA
The metastatic phase of Ewing’s sarcoma is treated by chemotherapy coupled with surgery or radiation therapy. The duration of the course, choice of medications, and surgical methods are chosen on a case-by-case basis.
CHEMOTHERAPY
The main treatment method of metastatic Ewings’ sarcoma is chemotherapy. Typically, the course takes from 12 to 16 weeks. If there are metastases, systemic combined chemistry (simultaneous use of several anticancer drugs) gives the best results.
HIGH-DOSE CHEMOTHERAPY WITH STEM CELL CONSERVATION
High doses of chemicals can destroy large tumors. However, such treatment has a negative impact on the organism as a whole, and especially on blood-producing cells. Stem cell therapy restores normal body functions after high-dose chemo.
Stem cells, taken from the blood or bone marrow, are then frozen and stored until the end of therapy. Preferably, the source of the cells is the patient themselves, but transplantation from a donor is possible. After the end of the treatment, the stored stem cells are returned to the patient. These reinfused particles implant and regenerate the blood cells. Stem cell saving chemotherapy treats localized and relapsing Ewing’s sarcoma.
SURGERY
Usually, surgery is performed after the tumor has been reduced in size by chemotherapy or radiation therapy. Then, the surgeon removes cancer’s body and metastatic tumors. In the affected limb is beyond saving, the specialist performs amputation. The hand or leg is then replaced by a fully functional prosthesis.
RADIATION THERAPY
Radiation therapy is used prior to surgery, after surgery, or as a stand-alone treatment. Oncologists recommend it against primary tumors and metastases.
RELAPSING EWING’S SARCOMA IN CHILDREN TREATMENT
Recurrent Ewing’s sarcoma is treatable with chemo, surgery, radiotherapy or a combination of these methods. If the child has already undergone chemotherapy, the doctors will prescribe different medications, or use a combination of drugs. Operational intervention and irradiation can remove recurrent tumors. Radiation exposure can also ease negative cancer symptoms (so-called palliative care).
TREATMENTS OF EWING’S SARCOMA THAT ARE UNDERGOING CLINICAL TRIALS
Kinase inhibitor. This is a group of drugs that can block proteins needed for cancer cell division. This prevents the tumor from growing and spreading.
Monoclonal antibody therapy. Laboratory produces monoclonal antibodies from immune cells. They can identify a tumor, stop its development and destroy cells without damaging healthy tissue. Specialists are looking into monoclonal antibodies (ganitumab) in the treatment of metastases in Ewing’s sarcoma.
Therapy with NEDD8-activating enzyme inhibitor (NAE). NAE inhibitors are medicines that attach themselves to the tumor and prevent cancer cell division.
T-cell CAR therapy. It is a type of immunotherapy that changes the child’s immunity and activates it to fight against cancer. T-cells destroy certain proteins on cancer’s surface. They are laboratory-grown and transmitted to the patient by infusion. This treatment is currently undergoing trial testing.
JUVENILE EWING’S SARCOMA PROGNOSIS
According to the American Cancer Society, about 70% of child patients with Ewing’s sarcoma are in stable remission and have passed the 5-year survival threshold. Adolescents aged 15 to 19 years have lower survival rates, about 56%. For kids with metastatic cancer, survival rates are below 30%.
Even in the late stages of cancer, there are promising treatment methods. High-dose chemotherapy paired with full-body irradiation and bone marrow transplantation can increase the survival of the patient.
IN WHICH COUNTRIES IS EWING’S SARCOMA TREATED AND HOW MUCH DOES IT COST?
Foreign patients choose leading clinics of Turkey, Germany, Spain, Austria, South Korea, and the Czech Republic. These include Liv Hospital, Quiron University Clinic in Barcelona, Ludwig-Maximilian University Clinic of Munich, Vienna Private Clinic, Soon Chun Hyang Hospital, etc.
The lowest prices for Ewing’s sarcoma therapy are in Turkish and Korean hospitals. The price of medical services there is 20-40% lower than in some European clinics. For example, the initial cost of surgery to remove Ewing’s sarcoma in Turkey is $18,000, autologous bone marrow transplantation – $45,000, a full course of chemotherapy – $7,000. To learn more about Ewing sarcoma treatment and prices abroad, please click here.
You can get detailed information on the treatment of Ewing sarcoma in children from MediGlobus coordinators. Our specialists will help you choose a clinic and a doctor, as well as arrange a medical trip in the shortest possible time.
