Commonly used combinations include doxorubicin + cyclophosphamide + methotrexate , CyVADIC (cyclophosphamide + vincristine + doxorubicin + dacarbazine), doxorubicin + ifosfamide , ifosfamide + etoposide , doxorubicin + cyclophosphamide and doxorubicin + dacarbazine + cyclophosphamide. Other combinations have been used, chiefly of these drugs but also of others available for investigational use.
Chemotherapy is part of the standard and optimal initial treatment for Ewing's sarcoma and osteosarcoma. For Ewing's sarcoma, radiation therapy of approximately 4,500 cGy is added. Surgery then follows for all patients with osteosarcoma and many patients with Ewing's sarcoma. Additional chemotherapy is mandatory for both Ewing's sarcoma and osteosarcoma after surgery. In some centers, another tumor specimen is examined for significant tumor destruction to see if the same chemotherapeutic agent should be given again.
Adjuvant Chemotherapy Even if a bone or soft tissue sarcoma is apparently localized and could apparently be completely removed, there is a significant risk that tumor cells too small to detect have already spread to other places in the body. Additional treatment with chemotherapy (adjuvant) attempts to eliminate these tumor deposits.
Adjuvant chemotherapy is commonly used for certain sarcomas, especially childhood sarcomas (rhabdomyosarcoma and Ewing's sarcoma) and osteosarcoma. The use of adjuvant chemotherapy for other sarcomas is under clinical investigation.