Adjuvant chemotherapy for localised resectable soft tissue sarcoma of
adultsSarcoma Meta-analysis Collaboration
A substantive amendment to this systematic review was last made on 24
September 1998. Cochrane reviews are regularly checked and updated if
necessary.
Data collection and analysis: Individual patient data were
obtained. Accuracy of data and quality of randomisation and follow-up of
trials was assessed.
Citation: Sarcoma Meta-analysis Collaboration. Adjuvant
chemotherapy for localised resectable soft tissue sarcoma of adults
(Cochrane Review). In: The Cochrane Library, Issue 3, 1999. Oxford: Update
Software.
Background and objectives: Adjuvant chemotherapy aims to lessen
the recurrence of cancer after surgery with or without radiotherapy. The
objective of this review was to assess the effects of adjuvant
chemotherapy in adults with resectable soft tissue sarcoma after such
local treatment.
Reviewers' conclusions: Doxorubicin-based adjuvant chemotherapy
appears to significantly improve time to local and distant recurrence and
overall recurrence-free survival in adults with localised resectable soft
tissue sarcoma. There is some evidence of a trend towards improved overall
survival.
Search strategy: We searched the Cochrane Controlled Trials
Register, UKCCCR Register of Cancer Trials, Physicians Data Query, EMBASE,
MEDLINE and CancerLit.
Selection criteria: Randomised trials of adjuvant chemotherapy
after local treatment in adults with localised resectable soft tissue
sarcoma were included. Only trials in which accrual was completed by
December 1992 were included.
Main results: Fourteen trials of doxorubicin-based adjuvant
chemotherapy involving 1568 patients were included. Median follow-up was
9.4 years. For local recurrence-free interval the hazard ratio with
chemotherapy was 0.73 (95% confidence interval 0.56 to 0.94). For distant
recurrence-free interval it was 0.70 (95% confidence interval 0.57 to
0.85). For overall recurrence-free survival it was 0.75 (95% confidence
interval 0.64 to 0.87). These correspond to significant absolute benefits
of 6-10% at 10 years. For overall survival the hazard ratio of 0.89 (95%
confidence interval 0.76 to 1.03) was not significant but potentially
represents an absolute benefit of 4% (95% confidence interval 1 to 9) at
10 years. There was no consistent evidence of a difference in effect
according to age, sex, stage, site, grade, histology, extent of resection,
tumour size or exposure to radiotherapy. However, the strongest evidence
of a beneficial effect on survival was shown in patients with sarcoma of
the extremities. |
