Ewing's sarcoma Treatment
Ewing's sarcoma as a result of a vicious high degree of short duration, transfer speed, if be treated by use a simple surgery, radiotherapy, single agent chemotherapy, the effect is not very satisfactory, the vast majority of patients died within 2 years, 5-year survival rate does not exceed 10%. In recent years the use of combination therapy for Ewing's sarcoma, so that the limitations of the treatment of Ewing's sarcoma after 5-year survival rate increased to above 75%.
1. Surgical treatment for Ewing's sarcoma: the past, surgery is the treatment of the main measures of this disease, along with radiotherapy and chemotherapy to improve efficacy and side effects produced by its gradual improvement strategies, using a simple surgical treatment of patients with diminishing. Current, amputation surgery is still one of the means of Ewing's sarcoma treatment.
The principle of surgery is completely remove the tumor, in order to maximize the reach of effective local control, prevention and reduction of tumor metastasis. On this basis, as much as possible retain the limb function and improve the quality of life of patients. The role of surgical treatment, therefore increasingly important. Pritchard reported that a group of body parts, such as Ewing's sarcoma, 47 cases of surgical treatment of patients, the 5-year survival rate was 44.7%; non-surgical treatment of 61 cases, 5-year survival rate was only 13.1%. Wilkin summed up the 13 years the treatment of 140 cases of Ewing's sarcoma of the experience, found that chemotherapy, radiotherapy and surgical treatment of patients with 5-year survival rate was 74% instead of surgical treatment of patients with 5-year survival rate of 27%, suggesting that conservative treatment better than surgery. These comprehensive data to show that the eradication of tumors than the effect of incomplete tumor resection for the gifted. Therefore, the patient's body as long as circumstances permit, should actively consider the primary surgery.
Commonly used in clinical surgery is the type of amputation or disarticulation, tumor excision, en bloc tumor resection and reconstruction surgery. In order to choose the correct surgery program, patients with pre-operative response to a comprehensive, carefully evaluated, according to patient's age, tumor location, tumor size and tumor adjacent to important anatomical organization, the decision on the surgery. Mostly due to the use of preoperative chemotherapy treatments, ranging from, the tumor needs to be valued on the degree of clinical response of chemotherapy, which often need to compare before and after chemotherapy in primary lesions of X-ray film, CT scan or MRI, to ensure that the operation is successful.
2. Radiotherapy for Ewing's sarcoma: Ewing's sarcoma is extremely sensitive to radiation therapy is the treatment of Ewing's sarcoma of the main measures. General to low-dose (3000 ~ 4000rad) radiation, the tumor can quickly shrink or disappear alleviate pain. However, poor long-term effect of radiotherapy alone. Larsson (1973) reported 64 cases, most of which radiotherapy alone, the combined surgical treatment of the individual. 5-year survival rate is only 17%. Dahlin (1981) reported 133 cases, Philip (1967) reported 39 cases of radiotherapy alone, and their 5-year survival rates were 15% and 24%; Dant (1982) reported 13 cases of simple to 60Co irradiation, radiation field, including the entire bone and soft tissue, the weekly dose 10Gy, total dose of 40 ~ 50Gy, the results of 13 cases in 9 cases (69.2%) disease-free survival period of 3 to 30 months, median survival time of 10.4 months, Fernadez radiotherapy alone reported 40 cases of partial recurrence rate was 47.5%. In view of this, most scholars advocate radiotherapy for Ewing's sarcoma should be used early, wide, and sometimes do still need to be lung, brain preventive irradiation, as Ewing's sarcoma in the marrow than the spread of the X-ray film shows a much broader. As a result of the development of modern imaging technology, CT, MRI and isotope bone scan, digital subtraction angiography clinical widely used technology that can clearly show the scope of the tumor in the medullary cavity, as well as the extent of soft tissue proliferation. Therefore, some scholars believe that the illuminated area may include the practical application of tumor 5cm from top to bottom, including normal tissue, so as to reduce radiation damage to normal tissues, especially children, may dispense with the backbone of the Department of Radiation Oncology of the epiphyseal growth inhibition caused. Irradiation dose-dependent reduction in tumor vary by primary tumors, such as trunk pelvis, spine radiation dose of 50 ~ 60Gy. Limb tumor 45 ~ 60Gy, in which the entire bone and 30 ~ 40Gy irradiation of primary tumor irradiation plus 10 ~ 15Gy. Daily exposure to 2Gy, week 5, radiotherapy in 5 ~ 6 weeks. In order to reduce local recurrence, and some scholars with high-dose irradiation for more than 60Gy.
3. Chemotherapy for Ewing's sarcoma: that of Ewing's sarcoma is currently effective drugs cyclophosphamide, adriamycin, dactinomycin, vincristine, BCNU and so on. A joint program is also a lot better for the CVD program (CTX + VCR + DACT + VCDA), CVDA program (in the CVD program based on ADM) and so on.
At present, Ewing's sarcoma commonly used anti-drug dose: cyclophosphamide 500 ~ 1200mg/m2, adriamycin 20 ~ 30mg/m2 and actinomycin D450μg/m2. Rosen, etc. are reported in four specific chemotherapy drug use; D450μg/m2 actinomycin intravenous injection, 1 times / day × 5, paragraphs 15 and 29 days of the beginning of doxorubicin 20 mg/m2 intravenous injection, 1 / day × 3, the beginning of the first 43 days of intravenous vincristine 1.5 mg/m2, 1 times / week × 4 and intravenous cyclophosphamide 1200 mg/m2, 1 / 2 weeks × 2,3 for 1 month treatment, treatment, treatment 8. The program has achieved 5-year survival rate of 75 percent better results.
Most of this disease occurred in the transfer of 2 years, so the general idea of chemotherapy to be continued for 2 years.
4. combination treatment for Ewing's sarcoma: an integrated treatment means surgery plus radiotherapy plus chemotherapy with or without surgery integrated treatment. Its methods are as follows:
1) radiotherapy plus chemotherapy: The main purposes of the operation can not be applied to patients, including patients with advanced, the use of medium, or large doses of radiotherapy combined with chemotherapy drugs. According to the specific circumstances of patients, radiotherapy and chemotherapy can be started at the same time or one after another application.
2) medium amount of surgical resection plus radiotherapy plus chemotherapy: as long as the tumor can be removed should be combined with moderate amount of additional radiation therapy combined with chemotherapy drugs. Some scholars now claim to be combined with chemotherapy, the tumor to be significantly reduced, re-resection of the implementation of large, remote replantation or bone graft, and bone, joint repair defect. Bone where the original tumor after radiotherapy 3500rad, coupled with the combination chemotherapy.
3) surgery with radiotherapy or chemotherapy: the application of this method is currently relatively small, only radiotherapy or chemotherapy can not be tolerated when used, and the efficacy of radiotherapy plus chemotherapy is better than not.
4) treatment for spread Ewing's sarcoma: the body as long as conditions permit, in support of therapy for primary tumors and bone metastases given radiotherapy combined with chemotherapy.