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Efficacy of Local Control Strategies for Ewing Sarcoma After Neoadjuvant Chemotherapy: A Network Meta-analysis

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Abstract

Objective

This network meta-analysis aimed at comparing the efficacy of local control strategies after neoadjuvant chemotherapy in patients with Ewing sarcoma.

Design

Network meta-analysis was used to synthesize direct and indirect evidence in a network of trials that compare multiple interventions and has the potential to rank the competing treatments according to the studied outcome.

Setting

There are three treatment options for local Ewing’s sarcoma after neoadjuvant chemotherapy, namely surgery, radiotherapy and surgery plus radiotherapy (SR).

Participants

Records of 2540 patients from 11 studies were analyzed.

Main outcome measures

Potentially relevant studies were retrieved from PubMed and Embase, and screened according to inclusion and exclusion criteria. Hazard ratios and the associated 95% confidence intervals were used to describe the efficacy of different interventions on 5-year local recurrence rate and 5-year event-free survival rate. Surface under the cumulative ranking curve (SUCRA) was calculated for ranking probabilities of different treatment.

Results

Compared with radiotherapy, surgery had better efficacy [local recurrence, OR (95% CI) 0.48 (0.33–0.87)] and SR had a similar effect as surgery [local recurrence, OR (95% CI) 0.50 (0.29–0.82)]. There were no statistically significant differences between three different local control strategies in 5-year local recurrence rate. SUCRA values suggested that surgery was better than SR for 5-year local recurrence rate (0.79 vs 0.70) and 5-year event free survival rate (0.67 vs 0.50), respectively.

Conclusions

Both surgery and SR were superior to radiotherapy in reducing 5-yer local recurrence of patients with Ewing sarcoma after neoadjuvant chemotherapy. Surgery had higher efficacy than SR on improving the prognosis of patients.

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Authors and Affiliations

  1. Department of Orthopaedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, No. 274, Zhijiang Middle Road, Jing’an District, Shanghai, 200071, China

    Haixia Zhu, Yumei Li, Xiaoliang Xie & Tianyou Fan

  2. Department of Orthopaedics, Jinshan Hospital of Fudan University, Shanghai, China

    Shichao Zhang

  3. Department of Orthopaedics, Wuxi People’s Hospital, Nanjing Medical University, Wuxi, China

    Yuntao Xue

Authors
  1. Haixia Zhu
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  2. Yumei Li
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  3. Xiaoliang Xie
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  4. Shichao Zhang
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  5. Yuntao Xue
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  6. Tianyou Fan
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Contributions

HZ,YL,XX: substantial contribution to the conception and design of the work; HZ,SZ,YX: acquisition, analysis, and interpretation of the data; HZ: drafting of the manuscript; TF: revising the manuscript critically. All authors have read and approved the final article.

Corresponding author

Correspondence to Tianyou Fan.

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Zhu, H., Li, Y., Xie, X. et al. Efficacy of Local Control Strategies for Ewing Sarcoma After Neoadjuvant Chemotherapy: A Network Meta-analysis. Indian Pediatr 57, 527–532 (2020). https://doi.org/10.1007/s13312-020-1850-6

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  • DOI: https://doi.org/10.1007/s13312-020-1850-6

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