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.
阅读完整摘要
Individually, randomised trials have not shown conclusively whether adjuvant chemotherapy benefits adult patients with localised resectable soft-tissue sarcoma.
研究目的
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.
检索策略
We searched the Cochrane Controlled Trials Register, UKCCCR Register of Cancer Trials, Physicians Data Query, EMBASE, MEDLINE and CancerLit.
纳入排除标准
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.
资料收集与分析
Individual patient data were obtained. Accuracy of data and quality of randomisation and follow-up of trials was assessed.
主要结果
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.
作者结论
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.
