Ewing's sarcoma: treatment with high-dose radiation and adjuvant chemotherapy.

Twenty-nine patients with pathologically proven Ewing's sarcoma without overt metastases at diagnosis were treated with a protocol designed by The Royal Marsden and St. Bartholomew's Hospital Children's Solid Tumour Group. They received megavoltage radiotherapy to the involved bone and adjuvant chemotherapy with a combination of four cytotoxic drugs. Comparison with a historical control group of 19 patients treated with local surgery or radiotherapy but no initial chemotherapy shows a significant improvement in survival for the study group (P = 0.022). Thirteen patients have failed on the protocol: eight at the original site, four in other bones and only one in the lungs. Sixteen patients remain alive and disease free, 11 of these for over 33 months. The treatment regimen was moderately toxic but there were no treatment-related deaths. These results confirm that an improved survival time and, hopefully, cure rate can be expected by treating Ewing's tumour with high-dose megavoltage radiation and combination chemotherapy. Future goals must be better control of primary lesions and eradication of micrometastases in other bones.