 A comprehensive search for guidelines was undertaken to identify the most

relevant guidelines to consider for adaptation. 

 inclusion/exclusion criteria followed in the search and retrieval of

guidelines to be adapted:

- Selecting only evidence-based guidelines (guideline must include a

 report on systematic literature searches and explicit links between

 individual recommendations and their supporting evidence).

- Selecting only national and/or international guidelines.

- Specific range of dates for publication (using Guidelines published or

 updated 2015 and later).

- Selecting peer reviewed publications only.

- Selecting guidelines written in English language.

- Excluding guidelines written by a single author not on behalf of an

 organization in order to be valid and comprehensive, a guideline

 ideally requires multidisciplinary input.

- Excluding guidelines published without references as the panel needs

 to know whether a thorough literature review was conducted and

 whether current evidence was used in the preparation of the

 recommendations.

 All retrieved Guidelines were screened and appraised using AGREE II

instrument (www.agreetrust.org) by at least two members. the panel decided

a cut-off points or rank the guidelines (any guideline scoring above 50% on

the rigour dimension was retained)

The NCCN guidelines are the main source used while formulating the national guidelines for Ewing Sarcoma.

 Evidence assessment

According to WHO handbook for Guidelines we used the GRADE (Grading

of Recommendations, Assessment, Development and Evaluation) approach

to assess the quality of a body of evidence, develop and report

recommendations. GRADE methods are used by WHO because these

represent internationally agreed standards for making transparent

recommendations. Detailed information on GRADE is available through the

on the following sites:

. GRADE working group: http://www.gradeworkingroup.org

 . GRADE online training modules: http://cebgrade.mcmaster.ca/

 . GRADE profile software: http://ims.cochrane.org/revman/gradepro

 Table 1: Quality of evidence in GRADE

The strength of the recommendation

The strength of a recommendation communicates the importance of adherence to the recommendation:

Strong recommendations

With strong recommendations, the guideline communicates the message that

the desirable effects of adherence to the recommendation outweigh the

undesirable effects. This means that in most situations the recommendation

can be adopted as policy.

Conditional recommendations

These are made when there is greater uncertainty about the four factors

above or if local adaptation must account for a greater variety in values and

preferences, or when resource use makes the intervention suitable for some,

but not for other locations. This means that there is a need for substantial

debate and involvement of stakeholders before this recommendation can be

adopted as policy.

 When not to make recommendations.

When there is lack of evidence on the effectiveness of an intervention, it may

be appropriate not to make a recommendation.