Chemotherapy, radiation therapy (RT) and surgery are all associated with early and long term side effects in Ewing sarcoma (ES) patients.
Multimodality therapy has improved cure rates significantly, but chemotherapy enhances RT induced toxicity.
ES patients have a relatively high risk of significant late effects.
Side Effects from RT can be classified into three groups:
1. EARLY (during treatment and the first month after RT)
2. EARLY DELAYED (up to 6 months after RT)
- Lhermitte's phenomenon (electric shock sensation radiating down the spine or into the limbs with flexion of the neck) due to transient demyelination of the thoracic cord sometimes seen after RT to thoracic spine.
3. LATE (90 days to many years after RT)
- Fibrosis and vascular changes occur with endothelial cell loss, proliferation, capillary occlusion, degeneration and hemorrhagic exudates.
- In children normal growth is affected with growth reduction and subsequent atrophy in the area treated.
- The severity of RT related side effects depends on:
- Age of the child at the time of therapy
- Total dose and fractionation of RT
- Concurrent chemotherapy increases the risk of RT induced side effects
- Treatment volume/organ treated (the larger the area is that is treated, the greater the risk of late effects and some organs are more sensitive to RT than others)
RT related long-term complications in ES:
Region treated with RT |
Long Term Effect |
RT to head and neck
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Pituitary and hypothalamic dysfunction:
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See link at bottom of page |
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Vascular disease (early atherosclerosis and fibrosis within blood vessels) with increased risk of:
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RT to pelvis |
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Large bowel toxicity:
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Musculoskeletal abnormalities:
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Increased risk of second malignancy within RT field
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RT to limb | Musculoskeletal abnormalities:
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Vascular insufficiency:
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RT to chest |
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Benign osteochondromas of ribs:
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Chemotherapy related long-term complications in ES:
Chemotherapy Agent |
Long Term Effect |
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(also called Etoposide) |
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Vincristine |
Supportive care related long-term complications in ES:
Supportive care |
Long Term Risk |
Blood transfusion prior to 1990 |
Transfusion acquired hepatitis C
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Recommended Link:
Lucy Graely was an author and poet. Her book "Autobiography of a face" described how Ewing sarcoma of the jaw affected her childhood and adolescence.
Here is an interview she did with Charlie Rose