학술논문
Evidence-based guideline recommendations on treatment strategies for localized Ewing's sarcoma of bone following neo-adjuvant chemotherapy.
Document Type
Academic Journal
Author
Werier J; The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada. Electronic address: ccopgi@mcmaster.ca.; Yao X; Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada. Electronic address: yaoxia@mcmaster.ca.; Caudrelier JM; The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.; di Primio G; St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.; Ghert M; Juravinski Cancer Centre, Hamilton, Ontario, Canada.; Gupta AA; The Hospital for Sick Children, Toronto, Ontario, Canada.; Kandel R; Mount Sinai Hospital, Toronto, Ontario, Canada.; Verma S; The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
Source
Publisher: Elsevier Science Country of Publication: Netherlands NLM ID: 9208188 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-3320 (Electronic) Linking ISSN: 09607404 NLM ISO Abbreviation: Surg Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: (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.
Recommendations: 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.
(Copyright © 2016 Elsevier Ltd. All rights reserved.)
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.
Recommendations: 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.
(Copyright © 2016 Elsevier Ltd. All rights reserved.)