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Treating Ewing Sarcoma
If you or your child has been diagnosed with Ewing sarcoma, your cancer care team will discuss treatment options with you. It’s important to weigh the benefits of each treatment option against the possible risks and side effects.
How is Ewing sarcoma treated?
The treatment of Ewing sarcoma depends on the location of the tumor, whether it has spread, a person’s overall health and preferences as well as other factors. Ewing sarcoma is usually treated with both local treatment (surgery and/or radiation) as well as chemotherapy (chemo). Some patients may be treated with targeted therapies as part of a clinical trial or if the cancer comes back or doesn’t respond to treatment.
The main types of treatment for Ewing tumors include:
Treatment of Ewing sarcoma, by stage
Treatment of Ewing sarcoma is based mainly on where it is in the body and how far it has spread when it's first found. Ewing sarcoma is considered localized if it is found mostly in 1 part of the body. If it has spread to other parts of the body, such as the lungs or the bone marrow, it is called metastatic.
A localized Ewing sarcoma appears to be confined to one area in the body, based on imaging tests and biopsy results. Even when testing shows Ewing sarcoma in one place, people with localized Ewing sarcoma tumors often still have small areas of cancer in other parts of the body that aren’t seen on imaging tests. Chemotherapy (chemo) is important for treating these cancer cells in other parts of the body so they do not grow and create other tumors. Chemo can reach all parts of the body.
Ewing sarcoma treatment begins with chemotherapy. It's called neoadjuvant chemotherapy because it's given before any surgery or radiation therapy. In the United States, patients are usually given a chemo regimen known as VDC/IE (or VAC/IE), which is a combination of vincristine, doxorubicin, and cyclophosphamide, alternating every two weeks with ifosfamide and etoposide, although other combinations of the same drugs are also effective.
After about 2 months of chemo, imaging tests such as CT, MRI, PET, or bone scans are done to see whether the tumor is shrinking (or at least isn't growing) and whether it can be surgically removed. If so, surgery is done at this point to remove part or all of the tumor when possible. A sample of the tumor is then sent to the lab to be looked at by a doctor, called a pathologist, under a microscope.
- If there are no cancer cells at or near the edges of the surgery specimen and all of the tumor was removed (called "negative margins"), chemotherapy will be continued for several more months to finish treatment.
- If cancer cells are found at or near the edges of the surgery specimen (called a "positive margin" meaning cancer cells may have been left behind), several weeks of radiation therapy is often added during the completion of chemotherapy.
If surgery can’t be done after the initial chemotherapy (because of the tumor location or some other reason), but the tumor is not growing, radiation therapy along with chemotherapy is often the next treatment given. In some cases, this might shrink the tumor enough so that surgery can then be done. This would then be followed by more chemotherapy, possibly with more radiation as well. In other cases where people can’t have surgery, radiation therapy and chemotherapy are the main treatments.
Making these treatment decisions often involves communication between many specialists, including medical or pediatric oncologists, surgical oncologists, and radiation oncologists.
If Ewing sarcoma continues to grow despite initial chemotherapy, different chemotherapy drugs may be tried. Surgery or radiation therapy may also be used to help keep the tumor under control. This may be followed by more chemotherapy.
Ewing sarcoma that has already spread (metastasized) to other areas of the body when it’s diagnosed is harder to treat than localized tumors. The outlook tends to be better when the cancer has spread only to the lungs, rather than to other bones or the bone marrow.
Treating metastatic disease is similar in many ways to treating localized disease. Chemotherapy is given first. After a few months, tests such as CT or MRI scans, bone or PET scans, and/or bone marrow biopsies are done to see how the cancer has responded .
If the cancer remains in only a few small areas after chemo, the main (primary) tumor and all known areas of metastasis may be removed with surgery at this point. Other approaches, such as surgery plus radiation therapy (before and/or after surgery) or just radiation therapy to all known metastatic sites, might also be options. During and after these treatments, chemotherapy is given for several months as well.
Making these treatment decisions often involves communication between many specialists including medical or pediatric oncologists, surgical oncologists and radiation oncologists.
Doctors have tried giving higher doses of chemo and different types of drugs to improve the outlook for people with metastatic disease, but many of these approaches have not proven successful. New clinical trials may offer new treatments and can be a good option in some cases.
If Ewing sarcoma does come back (recur or relapse), treatment depends on a number of factors, including:
- The location of the tumor
- Whether it has spread to different areas of the body
- What types of treatment were used before
- How long it has been since treatment
Chemotherapy, surgery, radiation therapy, or a combination of these may be used to treat recurrent tumors, depending on the situation. These tumors can be hard to treat, so clinical trials of newer treatments, such as targeted drugs or immunotherapy, may be a good option.
Who treats Ewing sarcoma?
Ewing sarcoma is rare, and treating it can be complex. It is important for people with Ewing sarcoma to be treated by a team of doctors experienced with bone tumors.
A team approach is recommended when treating Ewing sarcoma. For children and teens, treatment is best given at a children’s cancer center. For adults with Ewing tumors, treatment is typically given at a major cancer center. Doctors on the treatment team might include:
- An orthopedic surgeon (a surgeon who specializes in muscles and bones) who is experienced in treating bone tumors
- A medical or pediatric oncologist (a doctor who treats cancer with chemotherapy and other drugs)
- A radiation oncologist (a doctor who treats cancer with radiation therapy)
- A physiatrist (a doctor who directs a person’s rehabilitation and physical therapy)
For both adults and children, the team might also include other doctors, physician assistants (PAs), nurse practitioners (NPs), nurses, psychologists, social workers, physical therapists and other rehabilitation specialists, and other health professionals.
Making treatment decisions
The treatment for Ewing tumors can cause serious side effects.
It’s important to discuss all treatment options as well as their possible side effects with the cancer care team so you can make the decision that is best for you or your child. It’s also very important to ask questions if there's anything you’re not sure about.
Learn more in Talking to Your Child’s Cancer Care Team.
Questions to ask about Ewing sarcoma treatment
Understanding the diagnosis and choosing a treatment plan
- What are our treatment options?
- What do you recommend and why?
- Are there any clinical trials we should consider? How can we find out more about them?
- What is the goal of the treatment?
- What are the chances of curing the cancer with these treatment plans?
- Should I get a second opinion? How do I do that? Can you recommend a doctor or cancer center?
- How quickly do we need to decide on treatment?
- What will the treatment options be if the treatment does not work and the tumor comes back? What should I do to be ready for treatment?
During and after treatment
- How long will treatment last? What will it be like? Where will it be done?
- How will we know whether the treatment is working?
- Will the treatment be given in the hospital, clinic, or at home?
- How might treatment change our daily activities? Can I (or my child) attend work or school?
- Can I exercise during treatment? If so, what kind should I do, and how often?
- Are there any limits on what I (or my child) can do?
Side effects and long-term effects
- What risks or side effects are there to the treatments you suggest?
- Which side effects start shortly after treatment, and which ones might develop later on?
- Is there anything I can do to help manage or avoid side effects?
- What symptoms or side effects should I tell you about right away?
- Will treatment affect my child’s ability to grow and develop?
- Will treatment affect my or my child’s ability to have children in the future?
Support and resources
- How can I reach the cancer care team on nights, holidays, or weekends?
- Who can I talk to if I have questions about costs, insurance coverage, or social support?
- What type of follow-up and rehab will be needed after treatment?
- Do you know of any local or online support groups where I can talk to other people who have been through this?
Other things to consider
If time allows, consider getting a second opinion to feel more confident about the treatment plan you choose.
Clinical trials study new treatments and may offer access to promising options not widely available. They are also how doctors learn better ways to treat cancer. Ask your doctor about clinical trials you may qualify for.
You might hear about ways to relieve symptoms or treat your cancer, such as herbs, diets, acupuncture, massage, or many others. Integrative (holistic) methods are used with standard care, while alternative ones replace it. Some may help with symptoms, but many aren’t proven to work and could even be harmful. Talk with your care team first to make sure they’re safe and won’t interfere with treatment.
Preparing for treatment
Before treatment, the doctors and other members of the team will help you understand the tests that will need to be done.
Your (child’s) cancer care team will also often include a social worker. The team’s social worker will be there to support you and your family before, during, and after treatment. Adjusting to a new cancer diagnosis and its treatment plan can be tough, but your cancer care team is there to help.
Learn more in Helping Your Child Adjust to a Cancer Diagnosis or Preparing for Cancer Treatment.
Social and emotional health during treatment
Social and emotional distress may come up during and after treatment.
It can be normal to have some anxiety or other emotions about cancer and its treatment, but feeling overly worried, depressed, or angry can affect your health. It can get in the way of relationships, school, work, and other aspects of life. With support from family, friends, other survivors, mental health professionals, and others, many people who have survived cancer can thrive despite the challenges they have had to face.
Ewing sarcoma and its treatment can have a profound effect on how a person views themselves and their body. It can also affect how they do some everyday tasks, including certain school, work, or recreational activities. Some people may also have a hard time being away from work, friends, and activities they enjoyed before cancer. These impacts are often greatest during the first year of treatment, but they can be long-lasting in some people.
Self-esteem, self-image, and social development can be addressed with support and encouragement. Many cancer centers have special support programs and services to help people with cancer and their families during treatment and for many years after treatment ends. Reach out to your cancer center for help when needed. This may include services like counseling, social events, or support groups.
Children and adolescents
People diagnosed in childhood or adolescence may have unique needs during and after treatment. Depending on their age, they may also have some problems with relationships and keeping up with school.
Many experts recommend that school-aged patients attend school as much as they can. This can help them maintain a routine and tell their friends what is happening.
Friends can be a great source of support, but patients and parents should understand that some people may have wrong ideas about cancer and fears of their own. Some cancer centers have school re-entry programs that can help in these situations. In these programs, health educators visit the school and tell students about cancer, its treatment, and what changes they may notice in their classmate. They also answer any questions their class might have. Learn more in Going to School During and After Cancer Treatment.
Family members
Parents, siblings, and other family members can also be affected, emotionally and in other ways. Some common family concerns during treatment include:
- Financial stress
- Traveling to and staying near the cancer center
- The need to take time off from work
- The need for homeschooling
Social workers and others at your treating center can help sort through these issues.
Centers that treat many children with cancer may have programs to introduce new patients and their families to others who have finished their treatment. This can give them an idea of what to expect during and after treatment, which can be very important.
Help getting through cancer treatment
Your cancer care team will be your first source of information and support, but there are other resources for help when you need it. Hospital- or clinic-based support services also can be an important part of your care. These might include nursing or social work services, financial aid, nutrition advice, rehab, or spiritual help. For children and teens with cancer and their families, other specialists can be an important part of care as well.
The American Cancer Society also has programs and services – including rides to treatment, lodging, and more – to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.
The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask your cancer care team any questions you may have about your treatment options.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Gebhardt MC, DuBois SG, Baldini EH. Treatment of Ewing sarcoma. UpToDate. 2025. Accessed at https://www.uptodate.com/contents/treatment-of-ewing-sarcoma on October 21, 2025.
Lessnick SL, Grohar PJ, DuBois SG, Hogendoorn PCW, et a. Chapter 27: Ewing Sarcoma. In: Blaney SM, Adamson PC, Helman LJ, eds. Pizzo and Poplack’s Pediatric Oncology. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2021.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Bone Cancer. v.1.2026 – September 11, 2025. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/bone.pdf on October 21, 2025.
National Cancer Institute. Ewing Sarcoma Treatment. Accessed at https://www.cancer.gov/types/bone/hp/ewing-treatment-pdq on October 21, 2025.
Last Revised: January 12, 2026
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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