背景:骨尤文肉瘤的局部治疗涉及手术,放疗或两者兼而有之。治疗的选择取决于肿瘤的解剖范围,拟议治疗的有效性,其发病率,和治愈的期望。然而,不仅个体患者之间的局部治疗方法有所不同,而且在治疗中心和国家之间。我们的目的是探索实践中的差异,并就当地治疗达成共识。
方法:与国际合作者一起使用了三阶段改进的Delphi技术。这涉及一个专家小组来确定争议领域,对国际合作者的在线调查和在伦敦的共识会议,2017年6月英国。在协商一致的会议上,临床医生团队讨论了选定病例的当地管理,并通过电子投票收集他们的反应.
结果:确定了共识较大或较小的区域。注意到缺乏支持不同方法的证据,合作研究的领域变得显而易见。
结论:这表明,在骨尤文肉瘤的局部治疗的许多方面,国际上已经达成共识,包括使用专家多学科小组(MDT)会议,以获得所有适当的治疗。然而,仍然存在相当大的差异,包括使用不同的分期调查,决策,反应的定义,以及放疗剂量和时机。应开展进一步的协作工作,以确定这些变化的影响,从而确定最佳做法。
BACKGROUND: The local treatment of Ewing sarcoma of bone involves surgery, radiotherapy or both. The selection of treatment depends on the anatomical extent of the tumour, the effectiveness of the proposed treatment, its morbidity, and the expectation of cure. However, not only are there variations in the approach to local treatment between individual patients, but also between treatment centres and countries. Our aim was to explore variation in practice and develop
consensus statements about local treatment.
METHODS: A three stage modified Delphi technique was used with international collaborators. This involved an expert panel to identify areas of controversy, an online survey of international collaborators and a
consensus meeting in London, UK in June 2017. In the
consensus meeting, teams of clinicians discussed the local management of selected cases and their responses were collected with electronic voting.
RESULTS: Areas of greater or less
consensus were identified. The lack of evidence underpinning different approaches was noted and areas for collaborative research became apparent.
CONCLUSIONS: This has demonstrated that there is an international
consensus around many aspects of the local treatment of Ewing sarcoma of bone, including the use of specialist MultiDisciplinary Team (MDT) meetings with access to all appropriate treatments. However, considerable variation remains including the use of different staging investigations, decision making, definitions of response, and radiotherapy doses and timing. Further collaborative work should be undertaken to determine the impact of these variations in order to define best practice.