Evidence-based guideline recommendations on treatment strategies for localized Ewing's sarcoma of bone following neo-adjuvant chemotherapy.
OBJECTIVE
(1) To provide recommendations regarding the choice of surgery, radiation therapy (RT), or the combination of surgery plus RT in patients with localized Ewing's sarcoma of bone following neoadjuvant chemotherapy. (2) To determine the appropriate surgical planning imaging (pre-chemotherapy magnetic resonance imaging [MRI] or post-chemotherapy MRI) to identify optimal resection margins in patients with localized Ewing's sarcoma who undergo surgery following neoadjuvant chemotherapy.


METHODS
MEDLINE, EMBASE, the Cochrane Library (1999 to February 2015), main guideline websites, and relevant annual meeting abstracts (2012 to January 2015) were searched. Internal and external reviews were conducted.


CONCLUSIONS
1. Recommendation (1) - In patients with localized Ewing's sarcoma of bone following neoadjuvant chemotherapy: (a) Surgery alone or RT alone are two reasonable treatment options; the combination of surgery plus RT is not recommended as an initial treatment option. (b) The local treatment for an individual patient should be decided by a multidisciplinary tumour board together with the patient after consideration of the following: (1) patient characteristics (e.g., age, tumour location, tumour size, response to neoadjuvant chemotherapy, and existing comorbidities), (2) the potential benefit weighed against the potential complications from surgery and/or toxicities associated with RT, and (3) patient preferences. 2. Recommendation (2) - In patients with localized Ewing's sarcoma who will undergo surgery: (a) Both pre-chemotherapy and post-chemotherapy MRI scans should be taken into consideration for surgical planning. In certain anatomic locations with good chemotherapy response, the post-chemotherapy MRI may be the appropriate imaging modality to plan surgical resection margins.
The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada. Electronic address: ccopgi@mcmaster.ca.
Joel
J
Werier
Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada. Electronic address: yaoxia@mcmaster.ca.
Xiaomei
X
Yao
The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
Jean-Michel
JM
Caudrelier
St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
Gina
G
di Primio
Juravinski Cancer Centre, Hamilton, Ontario, Canada.
Michelle
M
Ghert
The Hospital for Sick Children, Toronto, Ontario, Canada.
Abha A
AA
Gupta
Mount Sinai Hospital, Toronto, Ontario, Canada.
Rita
R
Kandel
The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
Shailendra
S
Verma
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000592:standards* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D006801:Humans; D020360:Neoadjuvant Therapy; D017410:Practice Guidelines as Topic / Q000592:standards*; D012512:Sarcoma, Ewing / Q000628:therapy*