title: Ewing's sarcoma: A combined approach in the management.
abstract: Twenty-seven histologically confirmed cases of localised Ewing's sarcoma were treated by two different regimes. Radiotherapy alone was used in 13 cases and a combination of chemotherapy and radiotherapy in 14. Single agent chemotherapy (cyclophosphamide) was given sequentially in nine patients and cyclophosphamide and actinomycin-D in five. There is a significant difference in the response to these different regimes. Only 69.2% of patients treated by radiotherapy alone were disease-free, for a median period of 10.4 months and metastases were noticed in 53.8% of cases. The disease-free survival in patients treated by combination therapy (radiotherapy and chemotherapy) was 18.4 months and metastases were seen in only 42.9%. However, no metastases were seen in patients who received cyclophosphamide and actinomycin-D, during a period of 14 months and only one patient showed residual disease. It is concluded that the addition of cyclophosphamide alone is not adequate in the management of Ewing's sarcoma. Actinomycin-D in addition to cyclophosphamide has improved the disease-free survival period significantly. The optimum dose of radiotherapy and its combination with other chemotherapeutic agents needs further trials to find the best and most suitable schedule.
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use; D003609:Dactinomycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011879:Radiotherapy Dosage; D012512:Sarcoma, Ewing / Q000532:radiotherapy*
chemical_list: D003609:Dactinomycin; D003520:Cyclophosphamide