Tenneti Pavan, Zahid Umar, Iftikhar Ahmad, Yun Seongseok, Sohail Atif, Warraich Zabih, Anwer Faiz
Department of Medicine, University of Arizona, Tucson, AZ 85721, USA.
Department of Biostatics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85721, USA.
Sarcoma. 2018 Jun 3;2018:2640674. doi: 10.1155/2018/2640674. eCollection 2018.
Relapsed Ewing's sarcoma (RES) is an aggressive malignancy with poor survival. Although high-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) given after conventional chemotherapy (CC) has shown survival benefits, it is not generally used in the United States for RES. We performed a systemic review to evaluate the benefits of HDCT for RES.
Literature search involved Medline, Embase, and Cochrane database. We included studies with RES patients treated with HDCT/ASCT.
Twenty-four studies with total of 345 reported RES patients that got HDCT were included in final analysis. Seventeen studies had patients with multiple malignancies including RES, while seven had only RES patients. At 2 and 3-5 years, event-free survival (EFS) in studies with only RES patients ranged 42-47% and 20-61% and overall survival (OS) ranged 50-66% and 33-77%, respectively. In studies with combined patients that reported outcomes of RES separately, the EFS at 1-3 and 4 years was 36-66% and 17-50%, respectively. The OS at 1-2 and 3-4 years was 40-60% and 50-70%.
Most studies using HDCT/ASCT as consolidation regimen showed improved survival benefits compared to CC. Randomized controlled studies are needed to determine true clinical benefits of HDCT followed by ASCT in patients with RES.
复发性尤因肉瘤（RES）是一种侵袭性恶性肿瘤，生存率较低。尽管常规化疗（CC）后行高剂量化疗（HDCT）联合自体干细胞移植（ASCT）已显示出生存获益，但在美国，它一般并不用于RES的治疗。我们进行了一项系统评价，以评估HDCT对RES的疗效。
文献检索涉及Medline、Embase和Cochrane数据库。我们纳入了接受HDCT/ASCT治疗的RES患者的研究。
最终分析纳入了24项研究，共计345例接受HDCT治疗的RES患者报告。17项研究纳入了患有包括RES在内的多种恶性肿瘤的患者，而7项研究仅纳入了RES患者。在仅纳入RES患者的研究中，2年和3至5年的无事件生存率（EFS）分别为42%至47%和20%至61%，总生存率（OS）分别为50%至66%和33%至77%。在分别报告RES结局的合并患者研究中，1至3年和4年的EFS分别为36%至66%和17%至50%。1至2年和3至4年的OS分别为40%至60%和50%至70%。
与CC相比，大多数使用HDCT/ASCT作为巩固方案的研究显示出生存获益改善。需要进行随机对照研究来确定HDCT后行ASCT对RES患者的真正临床获益。
