When Should High-dose Chemotherapy and Autologous Stem Cell Transplantation Be Performed in a Pediatric Local High-Risk Ewing Sarcoma A Case Report

Abstract

In local high-risk Ewing Sarcoma, treatment approaches differ between COG (Children's Oncology Group) and Euro Ewing 2012 protocols. In Euro-Ewing protocol, high-dose chemotherapy and autologous stem cell transplantation is performed after local therapy. COG protocol includes fourteen chemotherapy regimens and local therapy after the fourth chemotherapy regimen. Targeted agents added to standard chemotherapy and novel agents for maintenance are warranted (11)(12)(13)(14). Here, we discuss the time of local therapy in stem cell rescue, high-dose chemotherapy, and autologous stem cell transplantation in this aggressive tumor. Our fifteen-year-old patient had right pelvic Ewing sarcoma with a volume higher than 400 ml. After three chemotherapy regimens, the tumor was inoperable and radiotherapy was applied. Stem cell rescue is performed after the fourth chemotherapy regimen. High-dose chemotherapy and autologous stem cell transplantation are planned for relapse consolidation (17). There is no consensus about the indication of high-dose chemotherapy and autologous stem cell transplantation in high risc Ewing sarcoma with an initial tumor volume > 400 ml.