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Ewing Sarcoma: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) is the use of medicines to kill cancer cells. The medicines attack and kill cells that grow quickly, like cancer cells. But some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.

When is chemo used for Ewing sarcoma? 

Chemo is a common part of the treatment for all Ewing sarcomas. This is because even if it looks like the cancer is only in the bone where it started, cancer cells have often already spread to other parts of the body. Chemo goes through the whole body, so it can kill these cancer cells. Without it, the cancer is much more likely to come back.

Your healthcare provider will likely recommend chemo in these cases:

  • As the first treatment for Ewing sarcoma no matter how far it's spread. Chemo can often shrink the main tumor. This might make surgery or radiation easier. It can also kill any cancer cells that have spread to other parts of the body. After chemo, surgery and/or radiation are used to remove or destroy the remaining tumor.

  • After surgery or radiation therapy. Chemo is often used after these treatments to kill any cancer cells that have been left behind. This decreases the chance that the cancer will come back later.

How is chemo given for Ewing sarcoma?

Before treatment starts, you’ll meet with an oncologist. This is a doctor who specializes in treating cancer with medicines (chemo). The doctor will discuss the treatment options with you and explain what you might expect. 

Chemo is most often given right into your blood through an IV (intravenous).The medicine might be given through a small plastic tube (catheter) that’s been put into a vein. In most cases, a long-term access device is recommended because treatment lasts a long time, and veins in the hands and arms tend to wear out. Your provider can talk with you about this option. The medicine may drip in slowly over several hours, or it may be given more quickly over a few minutes.

Chemo is usually given in an outpatient setting. That means that it's given at a hospital, clinic, or healthcare provider's office. You can go home after the treatment. Less often, you may need to stay in the hospital during treatment. Nurses will give the chemo and watch closely for problems or reactions during treatments. Since each chemo treatment may last for a while, you may want to take along something to do, such as a book, music, or videos.

To reduce the damage to healthy cells and to give them a chance to recover, chemo is given in cycles. Each cycle consists of 1 or more days of treatment, followed by some time to rest and recover. Cycles normally last 2 or 3 weeks. Most people get 4 to 6 cycles as part of their initial treatment, which usually lasts for several months. After surgery or radiation, chemo is given again. The total length of treatment is close to 1 year. Your healthcare provider will talk about your schedule with you.

What chemo medicines are used to treat Ewing sarcoma?

These are some common chemo medicines used to treat Ewing sarcoma:

  • Cyclophosphamide

  • Doxorubicin

  • Etoposide

  • Ifosfamide

  • Vincristine

Chemo for Ewing sarcoma is given as a combination of medicines. The most common chemo combo used in the U.S. is vincristine, doxorubicin, and cyclophosphamide, alternating with ifosfamide and etoposide. You may hear this called VDC/IE.

What are common side effects of chemo?

Side effects of chemo are different for everyone. They depend on which medicines are used. Most can be treated and nearly all go away after treatment is over. Ask your healthcare provider what side effects to watch for. Tell them about any side effects right away. It's important to treat them before they get worse.

These are some of the more common side effects of chemo:

  • Hair loss. Hair grows back after treatment stops.

  • Nausea and vomiting. This side effect can often be controlled with medicines.

  • Mouth sores. Chemo can sometimes cause mouth sores. They might make it hard to eat or swallow.

  • Diarrhea. Talk with your healthcare provider about antidiarrheal medicines.

  • Loss of appetite or changes in the way things taste. Talk to your healthcare provider if you have trouble eating or are losing weight. There are often ways to help.

  • Increased risk for infection. During chemo treatments, your white blood cell count may become low. This means your immune system won’t work as well as it should. It’s a good idea to stay away from people who have illnesses during this time. It’s also a good idea to take extra care to prevent cuts and scrapes that could become infected. Blood counts are regularly checked during treatment. Let the healthcare provider know about any signs of infection, such as fever, sore throat, a new cough, or burning during urination.

  • Bleeding and bruising more easily. Chemo can also lower blood platelet counts. Platelets are needed to help the blood clot normally. 

  • Fatigue. It's common to feel tired while getting chemo. This goes away over time once treatment ends. 

Some other side effects can happen with some chemo medicines. For example:

  • Cyclophosphamide and ifosfamide can harm the bladder. This might cause problems with urination.

  • Vincristine can damage nerves. This may cause tingling and numbness, especially in the hands or feet. It can also cause constipation by affecting the nerves that play a role in bowel function.

  • Doxorubicin might damage muscles in the heart.

  • Some chemo medicines might affect fertility or the ability to have children later in life.

  • Some medicines can raise the risk for another cancer such as leukemia in the future.

Working with your healthcare provider

It's important to know which medicines you're taking. Write the medicines down. Ask the healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For example, chemo can make infections more likely. Know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. A written list will make it easier to remember your questions when you go to appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage side effects.

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Lu Cunningham
Online Medical Reviewer: Richard LoCicero MD
Date Last Reviewed: 12/1/2018
© 2019 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare provider's instructions.