Doxorubicin after initial treatment for sarcoma reduces risk of recurrence

Usually at diagnosis sarcoma shows no sign of having spread outside the original site and treatment is surgery (with/without radiotherapy). In about half the patients the cancer recurs. There is evidence that doxorubicin-based chemotherapy after initial treatment reduces recurrence, either at the original site or elsewhere in the body. Chemotherapy also seems to increase the length of time patients live, but this is less certain.Greater benefit was seen in men and those whose tumour originated in a limb, but these results may have occurred by chance.

Authors' 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.

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Background: 

Individually, randomised trials have not shown conclusively whether adjuvant chemotherapy benefits adult patients with localised resectable soft-tissue sarcoma.

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.

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.

Data collection and analysis: 

Individual patient data were obtained. Accuracy of data and quality of randomisation and follow-up of trials was assessed.

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 (HR) with chemotherapy was 0.73 (95% Confidence Interval (CI) 0.56 to 0.94). For distant recurrence-free interval it was 0.70 (95% CI 0.57 to 0.85). For overall recurrence-free survival it was 0.75 (95% CI 0.64 to 0.87). These correspond to significant absolute benefits of 6 to 10% at 10 years. For overall survival (OS) the HR of 0.89 (95% CI 0.76 to 1.03) was not significant but potentially represents an absolute benefit of 4% (95% CI 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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