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

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

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.

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

Records of 2540 patients from 11 studies were analyzed.

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.

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.

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.