Abstract：
BACKGROUND: Multidrug chemotherapy for Ewing sarcoma can lead to severe myelosuppression. We proposed two clinical questions (CQ): CQ #1, \"Does primary prophylaxis with G-CSF benefit chemotherapy for Ewing sarcoma?\" and CQ #2, \"Does G-CSF-based intensified chemotherapy improve Ewing sarcoma treatment outcomes?\".
METHODS: A comprehensive literature search was conducted in PubMed, Cochrane Library, and Ichushi web databases, including English and Japanese articles published from 1990 to 2019. Two reviewers assessed the extracted papers and analyzed overall survival (OS), febrile neutropenia (FN) incidence, infection-related mortality, quality of life (QOL), and pain.
RESULTS: Twenty-five English and five Japanese articles were identified for CQ #1. After screening, a cohort study of vincristine, ifosfamide, doxorubicin, and etoposide chemotherapy with 851 patients was selected. Incidence of FN was 60.8% with G-CSF and 65.8% without; statistical tests were not conducted. Data on OS, infection-related mortality, QOL, or pain was unavailable. Consequently, CQ #1 was redefined as a future research question. As for CQ #2, we found two English and five Japanese papers, of which one high-quality randomized controlled trial on G-CSF use in intensified chemotherapy was included. This trial showed trends toward lower mortality and a significant increase in event-free survival for 2-week interval regimen with the G-CSF primary prophylactic use compared with 3-week interval.
CONCLUSIONS: This review indicated that G-CSF\'s efficacy as primary prophylaxis in Ewing sarcoma, except in children, is uncertain despite its common use. This review tentatively endorses intensified chemotherapy with G-CSF primary prophylaxis for Ewing sarcoma.
METHODS: A comprehensive literature search was conducted in PubMed, Cochrane Library, and Ichushi web databases, including English and Japanese articles published from 1990 to 2019. Two reviewers assessed the extracted papers and analyzed overall survival (OS), febrile neutropenia (FN) incidence, infection-related mortality, quality of life (QOL), and pain.
RESULTS: Twenty-five English and five Japanese articles were identified for CQ #1. After screening, a cohort study of vincristine, ifosfamide, doxorubicin, and etoposide chemotherapy with 851 patients was selected. Incidence of FN was 60.8% with G-CSF and 65.8% without; statistical tests were not conducted. Data on OS, infection-related mortality, QOL, or pain was unavailable. Consequently, CQ #1 was redefined as a future research question. As for CQ #2, we found two English and five Japanese papers, of which one high-quality randomized controlled trial on G-CSF use in intensified chemotherapy was included. This trial showed trends toward lower mortality and a significant increase in event-free survival for 2-week interval regimen with the G-CSF primary prophylactic use compared with 3-week interval.
CONCLUSIONS: This review indicated that G-CSF\'s efficacy as primary prophylaxis in Ewing sarcoma, except in children, is uncertain despite its common use. This review tentatively endorses intensified chemotherapy with G-CSF primary prophylaxis for Ewing sarcoma.
摘要：
背景：尤文肉瘤的多药化疗可导致严重的骨髓抑制。我们提出了两个临床问题（CQ）：CQ＃1，“G-CSF的一级预防对尤文肉瘤的化疗有益吗？”和CQ＃2，“基于G-CSF的强化化疗是否改善尤文肉瘤的治疗结果？”。
方法：在PubMed，科克伦图书馆,和Ichushi网络数据库，包括1990年至2019年发表的英语和日语文章。两名审稿人评估了提取的论文，并分析了总体生存(OS)，发热性中性粒细胞减少症（FN）的发生率，感染相关死亡率，生活质量（QOL），和痛苦。
结果：为CQ#1确定了25篇英文文章和5篇日文文章。筛选后,长春新碱的队列研究,异环磷酰胺,阿霉素,选择依托泊苷化疗851例。G-CSF的FN发生率为60.8％，无G-CSF的FN发生率为65.8％；未进行统计测试。操作系统上的数据，感染相关死亡率，QOL,或疼痛不可用。因此,CQ#1被重新定义为未来的研究问题。至于CQ#2，我们发现了两篇英文论文和五篇日文论文，其中包括一项关于在强化化疗中使用G-CSF的高质量随机对照试验。该试验显示，与3周间隔的G-CSF主要预防性使用的2周间隔方案相比，死亡率降低和无事件生存率显着增加的趋势。
结论：本综述表明G-CSF作为尤文肉瘤的初级预防的疗效，除了儿童，是不确定的，尽管它的普遍使用。这篇综述暂时支持尤文肉瘤的G-CSF初级预防强化化疗。
方法：在PubMed，科克伦图书馆,和Ichushi网络数据库，包括1990年至2019年发表的英语和日语文章。两名审稿人评估了提取的论文，并分析了总体生存(OS)，发热性中性粒细胞减少症（FN）的发生率，感染相关死亡率，生活质量（QOL），和痛苦。
结果：为CQ#1确定了25篇英文文章和5篇日文文章。筛选后,长春新碱的队列研究,异环磷酰胺,阿霉素,选择依托泊苷化疗851例。G-CSF的FN发生率为60.8％，无G-CSF的FN发生率为65.8％；未进行统计测试。操作系统上的数据，感染相关死亡率，QOL,或疼痛不可用。因此,CQ#1被重新定义为未来的研究问题。至于CQ#2，我们发现了两篇英文论文和五篇日文论文，其中包括一项关于在强化化疗中使用G-CSF的高质量随机对照试验。该试验显示，与3周间隔的G-CSF主要预防性使用的2周间隔方案相比，死亡率降低和无事件生存率显着增加的趋势。
结论：本综述表明G-CSF作为尤文肉瘤的初级预防的疗效，除了儿童，是不确定的，尽管它的普遍使用。这篇综述暂时支持尤文肉瘤的G-CSF初级预防强化化疗。
