The addition of ifosfamide and etoposide to a standard regimen does not affect the outcome for patients with metastatic disease, but it significantly improves the outcome for patients with nonmetastatic Ewing's sarcoma, primitive neuroectodermal tumor of bone, or primitive sarcoma of bone.

T1-weighted magnetic resonance (MR) images of the femur in 77 subjects, aged 1 month to 24 years, were retrospectively analyzed for the distribution and appearance of red and yellow marrow. The subjects were divided into six age groups, and the signal intensity and degree of mottling of marrow in the proximal epiphysis, proximal metaphysis, diaphysis, distal metaphysis, and distal epiphysis were observed and assigned a grade. Bone marrow with low or intermediate to slightly increased signal intensity was considered red marrow, while bone marrow with increased signal intensity was considered fatty marrow. An orderly progression of red to yellow marrow conversion in the femur was appreciated first in the diaphysis (ages 1-10 years) and then in the distal metaphysis (ages 10-20 years), with an adult pattern seen by age 24 years. The MR spectrum of red and yellow marrow differs from the existing macroscopic anatomical data because MR imaging is apparently more sensitive to the presence of microscopic fat in bone marrow.

Adding ifosfamide and etoposide to standard therapy does not improve outcomes of patients with Ewing's sarcoma or PNET of bone with metastases at diagnosis.