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Ewing Sarcoma: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines travel all over your body in your bloodstream. They attack and kill cells that grow quickly, such as cancer cells. Some normal cells also grow quickly. Because of this, chemo can harm those cells. This can cause side effects.

When is chemo used for Ewing sarcoma? 

Chemo is a common part of the treatment for Ewing sarcoma. This is because even if it looks like the cancer is only in the bone where it started, cancer cells tend to have already spread to other parts of the body. Chemo goes all over the whole body, so it can kill these cancer cells. Without chemo, the cancer is much more likely to come back.

Your healthcare provider will likely advise chemo in these cases:

  • As the first treatment for Ewing sarcoma, no matter how far it's spread.  Chemo can often shrink the main tumor. This might make surgery or radiation easier. It can also kill any cancer cells that have spread to other parts of the body. After chemo, surgery or radiation are used to remove or destroy the remaining tumor.

  • After surgery or radiation therapy. Chemo is often used after these treatments to kill any cancer cells that may be left in the body. This decreases the chance that the cancer will come back later.

How is chemo given for Ewing sarcoma?

Before treatment starts, you’ll meet with an oncologist. This is a doctor who specializes in treating cancer with medicines such as chemo. The doctor will talk with you about treatment options and what you might expect. 

Chemo is most often given right into your blood through an IV (intravenous) line. The medicine might be given through a small plastic tube (catheter) that’s been put into a vein in your hand or arm. But in most cases, a long-term access device is advised because treatment lasts a long time, and veins in the hands and arms tend to wear out. Your provider can talk with you about this option. The medicine may drip in slowly over several hours. Or it may be given more quickly over a few minutes.


You get chemotherapy in cycles over a period of time. That means you get the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is 1 cycle. Several cycles are given. Having treatment in cycles helps by:


  • Giving your body a rest. Treatment is hard on other cells that divide quickly. This includes cells in the lining of your mouth and stomach. This causes side effects, such as mouth sores and upset stomach. Between cycles, your body can heal and get a rest from the chemo.


Most people get 4 to 6 cycles as part of their initial treatment, which usually lasts for several months. After surgery or radiation, chemo is given again. The total length of treatment is about a year. Your healthcare provider will talk about your schedule with you.

What chemo medicines are used to treat Ewing sarcoma?

These are some common chemo medicines used to treat Ewing sarcoma:

  • Cyclophosphamide

  • Doxorubicin

  • Etoposide

  • Ifosfamide

  • Vincristine

Chemo for Ewing sarcoma is given as a combination of medicines. The most common combo used in the U.S. is vincristine, doxorubicin, and cyclophosphamide, alternating with ifosfamide and etoposide. You may hear this called VDC/IE.

What are common side effects of chemo?


These are some of the more common side effects of chemo:

  • Hair loss. Hair grows back after treatment stops.

  • Nausea and vomiting

  • Mouth sores. These might make it hard to eat or swallow.

  • Diarrhea

  • Loss of appetite or changes in the way things taste



  • Severe tiredness (fatigue). It's common to feel very tired while getting chemo. This goes away over time once treatment ends. 

Some other side effects can happen with certain chemo medicines. For instance:

  • Cyclophosphamide and ifosfamide can harm the bladder. This might cause blood in your urine.


  • Doxorubicin might damage muscles in the heart.


  • Some medicines can raise the risk for another cancer, such as leukemia, in the future.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of your medicines. Ask the healthcare team how they work and what side effects they might cause.



Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: L Renee Watson MSN RN
Online Medical Reviewer: Todd Gersten MD
Date Last Reviewed: 2/1/2021
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