Combined modality therapy of Ewing's sarcoma.

Since 1964, 66 consecutive patients with Ewing's sarcoma have been treated at the National Cancer Institute with local irradiation of the primary site combined with adjuvant regimens of progressively more intensive systemic chemotherapy. Actuarial survival rates for the total series show a 56% 2-year and 35% 5-year survival. The 43 patients without clinically detectable metastases at diagnosis have 64% 2-year and 52% 5-year survival rates. The current protocol, alternating high-dose pulses of adriamycin and cyclophosphamide-vincristine, is providing improved disease-free survival as compared to previous protocols, and indicates further progress toward the ultimate goal of complete tumor eradication. In addition to the problems of diagnostic accuracy in evaluating treatment results, other major factors influencing prognosis include initial metastatic disease, site of the primary tumor, age at diagnosis, and presence of systemic symptoms. At least these, and probably others, must be taken into account in developing randomized prospective trials for determination of optimal adjuvant therapy.