Surgery for Ewing's sarcoma
The choice depends on the type of operation and influence tumor localization operation on the function of the affected body part.
In many cases, the affected bone or softfabric can be completely surgically removed without disturbing the body functions. In other cases, preservation of organ function after complete removal of the tumor tissue is not possible.
If many years ago, Ewing's sarcoma of the upper andlower limbs were treated with amputation, the currently most commonly performed operations have stored. At the same time the removal of bones and joints are replaced with grafts or prostheses. Save the operation carried out even in patients with lesions of the pelvic bones.
In patients with Ewing's sarcoma lesions vital nerves and blood vessels instead of surgery radiation therapy may be used.
If localization Ewing sarcoma thorax is performed to remove the tumor, along with several ribs, which are replaced with synthetic material.
Metastatic nodes in the lung removed during surgery thoracotomy. After surgery, these patients radiation therapy to the lung tissue.
From the immediate and long-term effectssurgical treatment of Ewing's sarcoma should be noted poor wound healing and infectious complications. This is due to earlier use of chemotherapy and radiation. After surgery, many patients with Ewing's sarcoma in need of rehabilitative treatment.
Chemotherapy Ewing's sarcoma
Chemotherapy patients with Ewing's sarcoma is carried outusing anticancer drugs administered usually intravenously rare inside. This method of treatment is applied to all patients, regardless of the stage of the disease.
The reason is that even in patients withprocess can be localized micrometastases, detectable only by microscopic examination. Therefore, the rejection of chemotherapy in patients with localized stage will eventually lead to the growth of micrometastases.
For Ewing sarcoma chemotherapy use different combinations (combinations) anticancer drugs, are appointed every 3-4 weeks.
First, a combination of drugs,as vincristine, Adriamycin (doxorubicin) and cyclophosphamide. Once tested side effects of chemotherapy, a second combination comprising ifosfamide and etoposide. Such chemotherapy cycles are repeated 4-5 times.
Chemotherapy may be accompanied by variousside effects such as nausea, vomiting, anorexia, alopecia, lesions of the mucous membranes of the mouth and bladder, increased susceptibility to infections, menstrual irregularities, infertility, damage to the heart muscle.
The most serious, though rare complication of chemotherapy may be the second occurrence of cancer, particularly acute myeloid leukemia.
Radiation therapy of Ewing's sarcoma
In patients with Ewing's sarcoma is used outsideirradiation of high-energy sources. This tumor is highly sensitive to radiation, and most patients can be treated with a combination of chemotherapy and radiation.
The total dose of radiation therapy on the hearth is generally 45-55 Gy. According to the testimony of the irradiation of light, however, the dose of radiotherapy at the same time reduced.
Serious complications of radiation therapy includeviolation of bone growth. At the same time, the younger the child, the more pronounced side effects and complications. Radiation therapy can cause shortening of the limbs, facial deformation, etc.
Irradiation of the pelvis may result in bladder and colon. Radiation therapy to the area of the joint can cause a restriction of its function due to scarring.
Side-effects and complications of radiation therapy when exposed to the spinal cord and brain are shown in 1-2 years and are as headache and deterioration of mental activity.
High doses of radiation therapy (over 60 Gy) in 20% of the second lead to the development of malignant tumors.
Bone marrow transplantation and peripheral blood stem cells
Recently, patients with poor prognosis inSpecifically with bone metastases and bone marrow, having less than 10% survival rate, more intensive treatment is applied - with high doses of chemotherapy drugs to body irradiation and bone marrow transplantation or peripheral blood stem cells. This approach can cure more than 30% of patients with metastatic disease.
After the treatment of Ewing's sarcoma
After the whole treatment programEwing's sarcoma patients should be under the supervision of doctors and undergo periodic screening for complications, a possible recurrence or a second cancer.
The intervals between doctor visits are extended over time.