Vincristine, actinomycin D, and cyclophosphamide (VAC) were administered to 14 
patients with Ewing's sarcoma. The primary tumors were treated with radiation 
therapy and concurrent chemotherapy. Nine patients had no visible metastases at 
diagnosis: two died following the development of pulmonary metastases and the 
rest have been free of disease for periods varying from 4 months to 4 1/2 years 
following completion of treatment. This contrasts with a 27% survival in 
patients previously treated at this center with single agent chemotherapy. Five 
other patients had demonstrable metastases at diagnosis: VAC chemotherapy 
achieved complete regression of pulmonary metastases in three for 9, 9+ and 24+ 
months, respectively. Following disappearance of tumor in the latter two, 
pulmonary irradiation was administered in an attempt to consolidate the 
response, but tumor recurred 6 months later. These patients eventually died of 
widespread disease although survival appeared prolonged in comparison to that 
seen in past experience. Chemotherapy was well tolerated, although three 
patients developed hemorrhagic cystitis, necessitating discontinuation of 
cyclophosphamide. The data suggest the potential for prolonged control and an 
increase in the cure rate with this therapeutic approach.