Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data

Details

Serval ID
serval:BIB_15693785425D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data
Journal
Lancet
Working group(s)
Sarcoma Meta-analysis Collaboration
ISSN
0140-6736 (Print)
ISSN-L
0140-6736
Publication state
Published
Issued date
1997
Volume
350
Number
9092
Pages
1647-1654
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov'tJ.
F. Tierney, L. A. Stewart, M. K. B. Parmar, C. D. M. Fletcher, G. Jones,V. Mosseri, M. Patel, M. C. R. deElvira, R. L. Souhami, R. Sylvester, T. Tursz, T. A.Alvegard, H. Sigurdsson, K. Antman, M. Bacchi, L. H. Baker, R. S. Benjamin, M. F.Brady, V. Bramwell, B. N. Bui, J. H. Edmonson, S. Leyvraz, G. A. Omura, J.Rouesse, L. Ryan, A. T. vanOosterom and J. C. Yang
Abstract
BACKGROUND: Individually, randomised trials have not shown conclusively whether adjuvant chemotherapy benefits adult patients with localised resectable soft-tissue sarcoma.METHODS: A quantitative meta-analysis of updated data from individual patients from all available randomised trials was carried out to assess whether adjuvant chemotherapy improves overall survival, recurrence-free survival, and local and distant recurrence-free intervals (RFI) and whether chemotherapy is differentially effective in patients defined by age, sex, disease status at randomisation, disease site, histology, grade, tumour size, extent of resection, and use of radiotherapy.FINDINGS: 1568 patients from 14 trials of doxorubicin-based adjuvant chemotherapy were included (median follow-up 9.4 years). Hazard ratios of 0.73 (95% CI 0.56-0.94, p = 0.016) for local RFI, 0.70 (0.57-0.85, p = 0.0003) for distant RFI, and 0.75 (0.64-0.87, p = 0.0001) for overall recurrence-free survival, correspond to absolute benefits from adjuvant chemotherapy of 6% (95% CI 1-10), 10% (5-15), and 10% (5-15), respectively, at 10 years. For overall survival the hazard ratio of 0.89 (0.76-1.03) was not significant (p = 0.12), but represents an absolute benefit of 4% (1-9) at 10 years. These results were not affected by prespecified changes in the groups of patients analysed. There was no consistent evidence that the relative effect of adjuvant chemotherapy differed for any subgroup of patients for any endpoint. However, the best evidence of an effect of adjuvant chemotherapy for survival was seen in patients with sarcomas of the extremities.INTERPRETATION: The meta-analysis provides evidence that adjuvant doxorubicin-based chemotherapy significantly improves the time to local and distant recurrence and overall recurrence-free survival. There is a trend towards improved overall survival.
Keywords
Adolescent, Adult, Antibiotics, Antineoplastic/therapeutic use, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Chemotherapy, Adjuvant, Doxorubicin/therapeutic use, Female, Humans, Male, Middle Aged, Randomized Controlled Trials as Topic, Sarcoma/drug therapy, Sarcoma/mortality, Survival Analysis
Pubmed
Web of science
Create date
08/10/2011 17:11
Last modification date
20/08/2019 12:44
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