title: A systematic review of optimal treatment strategies for localized Ewing's sarcoma of bone after neo-adjuvant chemotherapy.
abstract: OBJECTIVE
  To perform a systematic review to investigate the optimal treatment strategy among the options of surgery alone, radiotherapy (RT) alone, and the combination of RT plus surgery in the management of localized Ewing's sarcoma of bone following neo-adjuvant chemotherapy.
  
  
  METHODS
  MEDLINE and EMBASE (1999 to February 2015), the Cochrane Library, and relevant conferences were searched.
  
  
  RESULTS
  Two systematic reviews and eight full texts met the pre-planned study selection criteria. When RT was compared with surgery, a meta-analysis combining two papers showed that surgery resulted in a higher event-free survival (EFS) than RT in any location (HR = 1.50, 95% CI 1.12-2.00; p = 0.007). However another paper did not find a statistically significant difference in patients with pelvic disease, and no papers identified a significant difference in overall survival. When surgery plus RT was compared with surgery alone, a meta-analysis did not demonstrate a statistically significant difference for EFS between the two groups (HR = 1.21, 95% CI 0.90-1.63). Both surgical morbidities and radiation toxicities were reported.
  
  
  CONCLUSIONS
  The existing evidence is based on very low aggregate quality as assessed by the GRADE approach. In patients with localized Ewing's sarcoma, either surgery alone (if complete surgical excision with clear margin can be achieved) or RT alone may be a reasonable treatment option. The optimal local treatment for an individual patient should be decided through consideration of patient characteristics, the potential benefit and harm of the treatment options, and patient preference.
authors.affiliation: The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Werier
authors.affiliation: Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada. Electronic address: yaoxia@mcmaster.ca.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Yao
authors.affiliation: The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Caudrelier
authors.affiliation: St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
authors.forename: Gina
authors.initials: G
authors.lastname: Di Primio
authors.affiliation: Juravinski Cancer Centre, Hamilton, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ghert
authors.affiliation: The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Abha A
authors.initials: AA
authors.lastname: Gupta
authors.affiliation: Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Rita
authors.initials: R
authors.lastname: Kandel
authors.affiliation: The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Verma
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000592:standards / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy*; D006801:Humans; D020360:Neoadjuvant Therapy; D011379:Prognosis; D012512:Sarcoma, Ewing / Q000188:drug therapy*
keywords: Ewing's sarcoma; Radiotherapy; Surgery; Systematic review