[MOL] Adjuvant chemo for localised resectable soft tissue sarcoma of adu [00051] Medicine On Line

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[MOL] Adjuvant chemo for localised resectable soft tissue sarcoma of adults.......

Adjuvant chemotherapy for localised resectable soft tissue sarcoma of adults

Sarcoma 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.

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