How is Ewing's sarcoma Treated?

This information has been written for patients, their families and friends and the general public to help you understand more about Ewing's sarcoma: what it is and the different types. This information is produced in accordance with BCRT's information policy.



 
Who is involved in deciding the treatment for Ewing's sarcoma?

Specialists in many different areas of medicine at hospitals in Ireland and at Bone Cancer Centres and the Regional Cancer Centres in the UK work together as a 'Multidisciplinary Team' (MDT). The Multidisciplinary Team' will work out the details of the treatment needed.

The MDT at the investigation (tests) and diagnosis stage will consist of:

Patients that are having treatment for Ewing's sarcoma will be under the care of the treatment and rehabilitation part of the multidisciplinary team including:

Treatment of Ewing's Sarcoma

Treatment for Ewing's sarcoma, involves treatment to the whole body with chemotherapy (systemic therapy) treatment of the tumour site with surgery and radiotherapy (local therapy)

Each Ewing's sarcoma patient has a slightly different treatment plan, depending on the stage of their disease and where in their body the cancer started.

Your doctor (oncologist) is the best person to describe to you the treatment choices. Your doctors will also tell you what is to be expected from the treatment. Treatment of cancer involves patients and the doctors working together to find a care or treatment plan that fits your needs.

 
Overview of treatment for Ewing's sarcoma

Following the diagnosis and the first tests, patients are given a combination of chemotherapy drugs before surgery. The number of drugs, how long they are given for and how many times they are given varies from country to country.

In the UK and Ireland, the standard treatment is to give the patient a series of different treatments, usually in this order:

Chemotherapy given before surgery is called neo-adjuvant (NEE-oh-AJOO-vant) chemotherapy. The aim of this course of chemotherapy is to shrink the primary tumour, and to kill any cells that have spread to other parts of the body.

Following a number of cycles of chemotherapy, the main tumour site is treated. Where possible this means that the patients have surgery to remove the primary tumour. This is more likely to be possible if the main (primary) tumour is in a limb (arm or leg) or easily accessible position in the body. For many patients the main tumour is not easily removable, for example, if the tumour is in the pelvis or spine.

When the tumour is removed, it is examined under a microscope by the pathologist, to make sure that the tumour has been completely removed and to find out how much of the tumour has been killed. The results of this examination may affect treatment after surgery.

After surgery, radiotherapy is given if

  • Not all the tumour is completely removed, or
  • If more than 10% of the tumour is still alive when examined under a microscope.

The exact dose and length of radiotherapy treatment will also be decided by a special team of doctors, but it is usually given as a single dose each day (a few minutes) for approximately 5 - 6 weeks.

Chemotherapy will usually continue after surgery (this is called adjuvant chemotherapy), and will be given during any radiotherapy treatment that the patient requires. This makes sure that any cancer cells that could have escaped from the primary tumour. are killed before they have a chance to grow into new tumours.

At diagnosis, 25-30% of patients have evidence that their cancer has spread to the lungs, other bones or to the bone marrow.

If there is evidence that the tumour has spread to other parts of the body then an oncologist and surgeon may consider removing the secondary cancers by surgery.

 
Ewing's sarcoma treatment in more detail

Chemotherapy before surgery(neo-adjuvant chemotherapy)

In the UK, Ireland and much of Europe the current standard treatment before surgery is made up of four chemotherapy drugs, which are given together: Vincristine, Ifosfamide, Doxorubicin, Etoposide (this is sometimes called VIDE). The combination of chemotherapy drugs is sometimes called a ‘protocol’ or ‘regimen’.

Drugs are given in a combination in order to maximise their effect. If the cancer stops responding to one of the drugs then the aim is that the other drugs will still be effective in killing the cancer cells.

Each course of these four drugs is given over 3-4 days every 3 weeks (1 cycle) for 6 cycles. This takes about 18 weeks in total.

Chemotherapy may be given as part of a clinical trial - a study used to investigate new or different treatments or side effects of treatments.

In some patients, chemotherapy is given to help slow down the growth of the tumour and decrease symptoms when their cancer is advanced and unable to be cured. This is known as ‘palliative chemotherapy ’.

Types of chemotherapy drugs used to treat Ewing's sarcoma:

Surgery

The decision about whether surgery is possible is usually taken by the multidisciplinary team, which includes expert surgeons.

The aim of surgery is to remove the primary tumour safely and at the same time try to keep the body working as normally as possible.

If the primary tumour is in a limb then it is usually possible to remove the tumour without removing the limb.

Surgeons have developed different surgical techniques to remove bone tumours whilst preserving the function of the limb. The main technique is replacement of the affected bone with a metal implant and false joint. Another technique is to carry out an autologous (aw-TOH-low-gus) bone graft in which a piece of healthy bone is taken from the patient to replace the bone that has been damaged by a tumour.

Other surgical techniques include resection alone (where just the tumour is removed), allografts (where donated tissue is used to rebuild the limb) and irradiation/ re-implantation, which is where the bone that contains the tumour is removed and treated with radiation. This kills any tumour cells inside the bone, and so the bone can be safely put back into the patient.

Despite these advances in surgical techniques around 10% of patients require an amputation (removal of the limb) to safely remove the tumour. Wherever possible a prosthetic (artificial) limb can be made for the patient. Amputation may also be needed if the cancer has spread to major blood vessels or nerves or if the patient develops a bad infection or other serious complications after limb-sparing surgery

Surgery to remove tumours that are not in the limbs, for example tumours that are in the pelvis, spine and skull, can be very complicated and requires very careful individual planning for each patient.

When compared with other bone tumours Ewing's sarcoma tumours respond well to radiotherapy. Sometimes when surgical removal is not possible, radiotherapy can be used alone to kill the cancer cells at the primary tumour site.

Surgery may also be used to remove secondary tumours, such as tumours in the lungs.

Surgery may be needed in future if the reconstruction of the limb wears out or if the tumour comes back.

Radiotherapy

Radiotherapy is a type of ‘local therapy’, meaning that it is designed to treat the tumour and not the whole body. Radiotherapy involves using a focussed beam of energy to kill the cancer cells that make up the tumour.

The energy used in radiotherapy is a high-energy form of X-rays. The energy beam damages the DNA inside the cancer cells inside the tumour, and this DNA damage prevents the cells from dividing, and causes the cells to die.

Radiotherapy is administered by a radiation oncologist. Radiotherapy is usually given as a single dose each day (a few minutes) for approximately 5 - 6 weeks.

Radiotherapy is sometimes used instead of surgery, in cases where surgical removal of the primary tumour is not be possible, for example if the tumour is in the pelvis or spine. Radiotherapy may also be used after surgery if not all the tumour is completely removed or more than 10% of the tumour is still alive when examined under a microscope.

Patients who receive radiotherapy may experience unpleasant side-effects from this treatment. These side effects can include:

  • Sore skin
  • Tiredness
  • Dry mouth and difficulty swallowing
  • Feeling sick, loss of appetite
  • Diarrhoea
  • Hair loss

Chemotherapy after surgery (adjuvant chemotherapy)

Once again, the number of drugs and length of treatment may be different from country to country. Most treatment courses last for a further 8 cycles over about 24 weeks after surgery.

In the UK, Ireland and much of Europe the current standard chemotherapy treatment after surgery is made up of the four drugs (Vincristine, Actinomycin D, Ifosfamide, Cyclophosphamide) and lasts for 24 weeks after surgery, (VAI for 1 cycle, VAC for 7 cycles). Chemotherapy given after the surgery is known as adjuvant (a-JOO-vant) chemotherapy.

 
What is chemotherapy and how does it work?

Chemotherapy, often called chemo (key-mo) for short, is the name for drugs used for the treatment of cancer. These drugs kill cancer cells by damaging the cell's DNA.

Cancer cells divide and grow rapidly, so chemotherapy drugs target rapidly dividing cells. Different chemotherapy drugs affect different parts of cells and that is why more than one drug may be given. This is called combination chemotherapy.

Most healthy cells are not in a state where they are dividing rapidly during every-day life. However, some cell types do divide rapidly, such as hair follicle cells, skin cells, bone marrow cells, and the cells that line the digestive system. This means chemotherapy drugs can also affect these 'healthy' cells and this is what causes side effects.

Side effects can be very unpleasant. These can include:

  • Nausea and vomiting
  • Diarrhoea
  • Hair loss
  • Mouth sores and ulcers
  • Taste changes (metallic taste, bitter taste)
  • Tiredness (fatigue)

Medications can be given after chemotherapy to help with some of these side effects. There are also tips on some good websites about dealing with side effects such as mouth sores, skin care and coping with hair loss.

Coping with hair loss: Teenage Info on Cancer (TIC) and Teenage Cancer Trust

Mouth sores and eating problems: Teenage Cancer Trust and TIC and Macmillan

A book written by a former osteosarcoma patient, Megan Blunt called Chemotherapy, Cakes and Cancer is available to download in PDF format published by CLIC Sargent.

 
How is chemotherapy given?

There are different ways patients are given chemotherapy: tablets, liquid medicine, injection or directly into the blood.

When a patient is given chemotherapy directly into their blood, the drug is given through a cannula (venflon), which is a flexible thin plastic tube that sits in a vein in the arm or hand. Alternatively, patients may have a central line, PICC or implantable ports (Portacath®).

Portacaths®, PICCs and central lines (Hickman lines) can be kept in for weeks or even a few months. These lines enable the number of needles required during treatment to be minimised and more than one drug or treatment (such as fluids or nutrition) can be given at the same time because the lines can have multiple openings or 'lumens'. Because central lines, PICCs and Portacaths® are all slightly different; the decision on which type of line will best suit the patient's needs can be discussed with the nurses and the doctor.

Figure 1(a). A Central Line. Image Courtesy of The Christie NHS Foundation Trust.

Figure 1(a). A Central Line. Image Courtesy of The Christie NHS Foundation Trust.
A central line (also known as a Hickman) is a tube that runs straight into a vein under the skin. The line is fitted under local anaesthetic. The outside end of the tube can be connected to a drip, and chemotherapy drugs can be given to the patient through the tube.

Figure 1(b). Peripherally Inserted Central Catheter (PICC). Image Courtesy of The Christie NHS Foundation Trust.

Figure 1(b). Peripherally Inserted Central Catheter (PICC). Image Courtesy of The Christie NHS Foundation Trust.
A PICC is a long, thin tube that is inserted into a vein in the arm, usually near the elbow. The tube is fed through the vein until the tip reaches a vein near the heart. The PICC is inserted under local anaesthetic.

Figure 1(c). Implantable Port, (Portacath®). Image Courtesy of The Christie NHS Foundation Trust.

Figure 1(c). Implantable Port, (Portacath®). Image Courtesy of The Christie NHS Foundation Trust.
Implantable ports (Portacath®) consist of a thin tube (catheter) and a port or chamber. The tube is implanted under the skin in the chest and sits in a vein near to the heart. The port is attached to the end of the tube and sits just under the skin. The port contains a thin rubber disc through which special needles can be attached to give chemotherapy and other I.V. treatments, fluids, and, to take blood samples. Implantable ports are usually inserted under a general anaesthetic, which means the patient is asleep.

The chemotherapy drug enters the blood through the cannula by an infusion usually called a drip. An infusion or drip is a method of giving a set amount (dose) of I.V. medications such as chemotherapy over a set period. This period can be hours or days. The infusion can also be controlled by an infusion pump, which is connected to a central line or a PICC line. Some of the pumps are small enough to fit in a pocket meaning that patients can use them at home.

Chemotherapy is given in 'cycles'. A cycle is the treatment time plus a resting time. For example, a patient may be given a combination of chemotherapy drugs over 3-4 days and then there may be a resting period of 2 and a half weeks. Therefore, the cycle is 3 weeks long. The resting period helps the healthy cells of the body to recover before the next treatment cycle begins.

 
High dose chemotherapy with autologous stem cell transplant

Some Ewing’s sarcoma patients may be offered high dose therapy with an autologous stem-cell transplant. Stem cells are the ‘master cells’ of the body, they are able to divide many times to make specialised cells that can replace damaged cells in the body. An ‘autologous stem cell transplant’ is when a patient’s own stem cells are collected from their blood, and then stored safely until they are given back to the patient after treatment.

This treatment allows the chemotherapy drugs to be used at a very high dose so that they have the highest possible impact on the cancer. The doses of chemotherapy drugs are so high that they cause serious damage to the cells in the blood, including the red blood cells that carry oxygen and the white blood cells which protect the body from infection. These cells can be replaced by the stem cells that are given back to the patient after treatment.

High dose chemotherapy with autologous stem cell transplant follows this treatment plan:

  • Stem cell harvest
    • Patients are given daily injections (Granulocte-Colony Stimulating Factor) in the run-up to the stem cell harvest. G-CSF is a molecular signal that encourages the production of more stem cells in the blood.
    • A blood test is done to test whether the numbers of white blood cells have increased and that the stem cells have moved from their usual home in the bone marrow, into the blood.
    • To carry out the harvest an apheresis catheter (a bit like a central line) is inserted into a large vein (either the top of the leg or the neck) in the operating theatre.
    • The catheter is linked by two lines to a machine called a cell separator. Blood from the patient passes though one line, into the cell separator. The stem cells are separated out from the blood and the cells are collected in a bag attached to the machine. The patient’s blood is then returned to the patient through the second line. The blood in the cell separator is treated with a drug called ACD-A to prevent it from clotting. This drug can have some side effects.
    • The number of stem cells collected in the bag will be counted. If there are too few stem cells, the procedure will be repeated the next day.
    • The aphresis catheter is removed when the harvest is complete.

The harvested stem cells are frozen and carefully stored until it is time to give the cells back to the patient.

  • High dose chemotherapy
    • The drugs used for high dose therapy are either Busulphan in combination with melphalan; or treosulphan in combination with melphalan (the second combination has less toxicity and so it is given to patients who have already experienced toxicity from previous treatment such as radiotherapy).
    • The high-dose drugs are given over the course of five days. After this there is a day’s rest before the stem cells are re-infused.

  • Autologous stem cell transplant
    • One day after the high-dose therapy has finished, the patient’s stem cells are infused back into the patient, using a drip.

Patients usually stay in hospital for three to four weeks, as it takes some time for the blood cells to recover. The levels of white blood cells usually get back to normal in around two weeks, but the platelet count can take a bit longer.

 
Where does treatment for Ewing's sarcoma take place?

Treatment for Ewing’s sarcoma can take place at different hospitals around the UK and Ireland. For patients whose nearest specialist hospital is too far away, a ‘shared care’ arrangement with a closer hospital might be set up. This means that the specialist hospital recommends a treatment plan, which is used to treat the patient at a hospital closer to home.

When patients arrive at their Regional Cancer Centre, more tests will be carried out to show how well organs such as the kidneys, heart, liver and ears are working, before treatment can begin. Tests may include blood tests, echocardiograms (heart scan) and an audiogram (hearing test). The measurements from these tests show doctors if these organs are working normally. This gives the doctors a ‘baseline’ to compare how well these organs are working as your treatment goes on.

The drugs used to treat Ewing’s sarcoma can affect these organs, so the tests are repeated during treatment. The measurements taken from the repeated tests are compared to the baseline; this helps the doctors to see if the organs are being affected.

Specialists in many different areas of medicine at hospitals in Ireland and at Bone Cancer Centres and the Regional Cancer Centres in the UK work together as a ‘Multi-Disciplinary Team’ (MDT). The Multidisciplinary Team will work out the details of the treatment needed (see ‘how is Ewing’s sarcoma diagnosed’ for information about MDTs).

England and Wales
For patients in England, diagnosis and surgery should take place in one of the Bone Cancer Centres (see map below).

For young patients any chemotherapy or radiotherapy treatments should be provided at one of the UK Specialist Children’s Cancer and Leukaemia Cancer Centre, Young Adult Cancer Centre, or Teenage Cancer Trust Unit.

Scotland
In Scotland the patients are treated at one of the five Sarcoma Centres that are part of the Scottish Sarcoma Network. These hospitals are in Aberdeen, Dundee, Edinburgh, Glasgow and Inverness. Patients visit one of these five Sarcoma Centres for any chemotherapy or radiotherapy treatment. For surgery, primary bone cancer patients go to Glasgow, Edinburgh or Aberdeen.

Republic of Ireland
Most patients in the Republic of Ireland aged under 16 receiving chemotherapy for Ewing’s sarcoma are seen at Our Ladys Hospital, Crumlin, Dublin.

Patients aged 15-19, are seen at Mater Misercordiae Hospital, Our Lady’s Hospital, Crumlin and Waterford Regional Hospital.

Patients aged over 20, are seen at Mater Misercordiae Hospital, Our Lady’s Hospital Crumlin, Sligo General Hospital, Cork University Hospital, Waterford Regional Hospital, St Vincent’s Hospital and Mercy Hospital.

Most patients (all ages) go to St. Marys Orthopaedic, Cappagh for surgery, and most patients (all ages) attend St Luke's and St Anne's Hospital, Dublin for radiotherapy. However, some patients may also attend other hospitals in Dublin and Cork.

Some Irish patients are referred to UK hospitals for their surgery.

Figure 8. A map of Bone Cancer Treatment Centres and Children and Young Adult Treatment Centres in the UK and Ireland.

Figure 8.  A map of  Bone Cancer Treatment Centres and Children and Young Adult Treatment Centres in the UK and Ireland.

 

Key to the centres shown on the map
Red starsSpecialist Children's Cancer and Leukaemia Centre
Blue stars:Bone Cancer Treatment Centre
Green stars:Children and Young People’s Integrated Cancer Service
Purple stars:Teenage Cancer Trust Unit
Yellow stars:Scottish Sarcoma Network Hospital

Bone Cancer Treatment Centres:

Most surgery for primary bone cancers in the UK is carried out at one the Bone Cancer Treatment Centres. These should also be the place where diagnostic tests, including bone biopsies, are carried out.

  • North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne Hospitals NHS Foundation Trust
  • Nuffield Orthopaedic Centre NHS Trust, Oxford
  • Royal National Orthopaedic Hospital, Stanmore, Middlesex
  • The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry
  • The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham

Teenage Cancer Trust Units:

  • Birmingham
    • Queen Elizabeth Hospital Young Person Unit
    • Birmingham Chidren’s Hospital
    • Royal Orthopaedic Hospital
  • Addenbrooke’s Hospital Cambridge
  • University Hospital of Wales, Cardiff
  • Royal Hospital for Sick Children, Edinburgh
  • Glasgow:
    • Beatson West of Scotland Cancer Centre
    • Royal Hospital for Sick Children (Yorkhill)
  • Castle Hill Hospital, Hull
  • Leeds:
    • St James’s University Hospital YoungAdult Unit
    • Leeds General Infirmary
  • Liverpool:
    • Alder Hey Children’s Hospital
  • London:
    • University College Hospital
    • University College Hospital Cancer Centre
  • Manchester:
    • The Christie Hospital Cancer Centre
  • Newcastle:
    • The Great North Children’s Hospital
    • The Freeman Hospital
  • Republic of Ireland
    • Our Lady’s Hospital, Crumlin (under construction)
  • Sheffield:
    • Weston Park Hospital
    • Royal Hallamshire Hospital
  • Southampton General Hospital
  • Surrey:
    • The Royal Marsden Hospital
  • The Wirral
    • Clatterbridge Centre for Oncology

Children's and Young Adults Specialist Cancer Treatment Centres and ‘Shared Care’ arrangements
For children, teenagers and young adults chemotherapy and radiotherapy are usually given at a Children’s and Young Adults Specialist Cancer Treatment Centre. If this centre is a long way from the patient’s home then a ‘shared care’ arrangement can be made with a local hospital. This means that the MDT at the Children’s Centre designs a treatment plan, and the local hospital administer the treatment, so that the patient doesn’t have to travel so far.

  • The Royal Liverpool and Broadgreen University Hospitals NHS Trust
  • Children’s Hospital for Wales, Cardiff
  • Great Ormond Street Hospital, London
    • Shared Care from here is offered at:
      • St Georges Hospital
      • Queen Elizabeth the Queen Mother Hospital, Margate
      • Royal Alexandra Children’s Hospital, Brighton
      • William Harvey Hospital, Ashford
      • Buckland Hospital Dover
      • Kent and Canterbury Hospital
      • Medway Maritime Hospital
  • Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne
  • Royal Belfast Hospital for Sick Children
  • Sheffield Children’s Hospital
  • Leeds General Infirmary
  • Our Lady’s Children’s Hospital, Dublin
  • Birmingham Children’s Hospital
  • Western Park Hospital, Sheffield
  • Beatson West of Scotland Cancer Centre, Glasgow
  • University College Hospital London
    • Shared Care from here is offered at:
      • Royal London Hospital
      • Meadway Maritime Hospital
      • Royal Alexandra Childen’s Hospital, Brighton
  • Bristol Royal Hospital for Children
    • Shared Care from here is offered at:
      • Great Western Hospital, Swindon
      • Gloucester Royal Hospital
      • Derriford Hospital Plymouth
      • Royal United Hospital Bath
      • Musgrove Park Hospital Taunton
      • Yeovil District Hospital
  • Alder Hey NHS Foundation Trust
    • Shared Care from here is offered at:
      • Wrexham Maelor Hospital
      • Ysbyty Glan Clwyd
  • Addenbrooks Hospital Cambridge
    • Shared Care from here is offered at:
      • Ipswich Hospital
  • The Royal Marsden Hospital
    • Shared Care from here is offered at:
      • St Georges Hospital, Tooting
      • Royal Alexandra Children’s Hospital, Brighton
      • East Surrey Hospital, Redhill
  • East Midlands Children’ and Young People’s Integrated Cancer Service
    • Formed from:
      • Leicester Royal Infirmary
      • Queen’s Medical Centre, Nottingham
  • Queen Elizabeth Hospital, Birmingham
  • Yorkhill Royal Hospital for Sick Children, Glasgow
    • Shared care from here is offered at:
      • Raigmore Hospital, Inverness
  • Royal Manchester Children’s Hospital
  • Southampton General
    • Shared Care from here is offered at:
      • Royal Alexandra Children’s Hospital

For older teenagers and young adults there are also specialist centres. These are sometimes part of a usual hospital ward, or some are designed and built by the Teenage Cancer Trust.

  • Leicester Royal Infirmary – Young Adult Oncology Service (CLIC Sargent)
  • Sheffield Teaching Hospital NHS Foundation Trust
    • Care for 13-16 yo at Sheffield Children’s hospital
    • Care for 16-19 yo at Weston Park Hospital or Royal Hallamshire Hospital
    • Care for patients aged 19-25 can choose which hospital to be treated at.
 
Complementary or Alternative Medicine (CAM)

Although complementary and alternative medicines are often called CAM for short as if they mean the same thing, there are differences between them. Other names you may see to describe CAMs are 'traditional medicines,' 'unconventional medicines' and 'integrated healthcare/ medicine.'

Alternative medicines or therapies, such as extract of mistletoe (iscador) and laetrile (bitter almonds) are used 'instead' of what are called conventional medicines. Conventional medicines for cancer are the treatments prescribed by doctors, for example, chemotherapy and radiotherapy.

Some people may choose to stop taking conventional medicines because they may no longer be working, or they may not wish to begin their treatment using conventional medicines for many different reasons. However, alternative medicines do not have to go through the very careful testing (trials) that conventional medicines do, and therefore may not be safe.

Adverts for alternative medicines on websites may claim to cure cancer. However, there is no scientific evidence to back these claims up. It is always best to talk to an oncologist if people are thinking about trying alternative therapies.

Complementary medicines are used alongside conventional medical treatment. Some patients use complementary medicine to help with symptoms or to aid relaxation.

Techniques used by some Ewing's sarcoma patients include:

  • Acupuncture
  • Massage therapy
  • Herbal products*
  • Vitamins* or special diets*
  • Visualization
  • Meditation
  • Spiritual healing.

* Patients should check with their medical team before taking any herbal products or supplements, or changing their diet. Some complementary medicines, such as antioxidants may interfere with conventional treatments.

 
Clinical trials are important

Doctors use clinical trials to test new treatments or changes to existing ones. Clinical trials usually have three stages called phases:

Phase 1: If a drug looks promising in laboratory studies, a phase 1 trial may be carried out. This is usually the first time a new drug is tried in people. These types of trials do not usually look at the effect on specific types of cancer but look at things such as side effects and the safest and most effective dose. These types of trials are usually done with a small number of people, usually 10-30.

Phase 2: This type of trial may be open to people with specific types of cancer or a number of different cancers. They are usually carried out on more patients than phase 1 trials, usually around 100; mainly to look at, which type of cancer the drug works best against, to look at the best dose and side effects again, and to find out if the drug is worth taking to a much larger phase 3 trial.

Phase 3: If a drug in a phase 2 trial looks as if it works as well or better than an existing treatment, a phase 3 trial is carried out. These trials are usually open to people with a specific type of cancer. Many more people are included in these trials, this helps to make sure doctors can see how well the drug may or may not help.

The new drug or treatment is usually compared to an existing treatment. Patients will be put into one of at least two groups. For example, either the 'new drug group' or the 'existing treatment group.' This is done randomly by a computer. Randomisation reduces bias and also helps doctors to be certain that it was the drug that caused the effect and it did not just happen by chance.

You may see the terms 'blind' or 'double blind' randomised clinical trial. A blind trial means the patient does not know if they are receiving the existing treatment or the new one. In a double blind trial neither the doctors or the patients know which treatment they have received.

A single phase 3 trial can be carried out in hospitals in many countries.

Clinical trials may not always be available, as the patient may not meet some of the requirements to be treated on a trial. If a clinical trial is suggested by the doctor, they will speak to, or give the patient information to read, about the trial.

Doctors will describe what taking part in the trial will mean for the patient, what happens before and during the trial and about possible risks. Patients will be given time to think about whether they wish to take part in the trial.

If a clinical trial is suggested by a doctor, as part of making a decision, patients or parents may want to think about the benefits and risks involved in taking part in a clinical trial. Benefits may be that parents and patients will have an active role in his or her health care, may have access to new treatments before they become generally available, and helping others by contributing to medical research.

Risks could include side effects of the drug, which may be unpleasant, or the treatment may not be safe or effective for the patient. The trial may involve frequent stays in hospital and extra cost. Upon contacting a trial coordinator, it may be helpful to have a list of questions written down.

 
Research into future treatments

Although Ewing's sarcoma survival has dramatically increased compared to the 1970s since chemotherapy has been used, the survival rate has barely changed since the mid-1980’s. Therefore, there is a need to find new treatment options for patients, especially those whose cancer has spread (metastasised).

Research into the biology of Ewing's sarcoma helps scientists to find specific targets for treatments. Targeted or specific treatments given alongside chemotherapy may help to improve survival rate and reduce any side effects and toxicity from treatment.

The Bone Cancer Research Trust is actively involved in funding research, especially translational research to help to find new treatments. Translational research is research that bridges the gap between promising findings in the laboratory from basic research and their clinical use in patients.


Ewing's sarcoma information Version 2, June 2013
Last reviewed: June 2013
Next review due: June 2015

The authors and reviewers of this information are committed to producing reliable, accurate and up to date content reflecting the best available research evidence, and best clinical practice. We aim to provide unbiased information free from any commercial conflicts of interest. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. BCRT can answer questions about primary bone cancers, including treatments and research but we are unable to offer specific advice about individual patients. If you are worried about any symptoms please consult your doctor.

The Information Standard Disclaimer
BCRT shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of BCRT.

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