Optimal Treatment Strategies for Localized Ewing's Sarcoma of Bone after Neoadjuvant Chemotherapy

Guideline Objective

• To make recommendations regarding the choice of surgery, radiation therapy (RT), or the combination of surgery plus RT for survival and local control in patients with localized Ewing’s sarcoma of bone following neoadjuvant chemotherapy.
• To determine the appropriate surgical planning imaging (pre-chemotherapy magnetic resonance imaging [MRI] or post-chemotherapy MRI) to identify optimum resection margins in patients with localized Ewing’s sarcoma who undergo surgery following neoadjuvant chemotherapy.

Patient Population

• Patients of any age diagnosed with localized Ewing's sarcoma of bone who have completed neoadjuvant chemotherapy for the first objective
• Patients of any age diagnosed with localized Ewing's sarcoma of bone who will undergo surgical management following neoadjuvant chemotherapy for the second objective

Intended Guideline Users

General surgeons, orthopaedic oncology surgeons, medical oncologists, radiation oncologists, pathologists, radiologists and other clinicians who are involved in the treatment of the target patients in the province of Ontario.

Research Question(s)

1. Among the options of surgery alone, RT alone, and the combination of RT plus surgery, which is the optimum treatment strategy to improve clinical outcomes (i.e., overall survival [OS], relapse-free survival [RFS]/progression-free survival [PFS]/event-free survival [EFS]/disease-free survival [DFS]/local control, toxicities/complications, and patient-reported outcomes) in patients with localized Ewing’s sarcoma of bone following neoadjuvant chemotherapy?
2. Between pre-chemotherapy MRI and post-chemotherapy MRI, which surgical planning imaging is the most appropriate to plan an optimal resection (e.g., negative margins) in patients with localized Ewing’s sarcoma of bone who undergo surgical resection following neoadjuvant chemotherapy?