Chemotherapy in Resectable Soft-Tissue Sarcoma

Fourteen trials of doxorubicin-based adjuvant chemotherapy involving 1568 patients were included in a Cochrane review [Abstract] 1. Median follow-up was 9.7 years. For local recurrence-free interval the hazard ratio with chemotherapy was 0.73 (95% CI 0.56 to 0.94). For distant recurrence-free interval it was 0.70 (0.57 to 0.87), and for overall recurrence-free survival it was +.75 (0.64 to 0.87). For overall survival the hazard ratio was 0.89 (0.76 to 1.03).

Another systematic review 2 including 15 RCTs with a total of 1,546 subjects was abstracted in DARE. The overall odds ratio for 2-year survival was 0.73 (95% CI 0.53 to 0.99) in favour of chemotherapy. The overall odds ratio for 5-year survival was 0.59 (95% CI 0.45 to 0.78) in favour of chemotherapy. This corresponds to a 12% improvement in absolute survival in 5 years (NNT = 8.3).

Comment: The authors have initiated an international collaborative meta-analysis, analysing individual patient data, to overcome problems with the current review.

References

• Sarcoma Meta-analysis Collaboration (SMAC)* (see Acknowledgements Section for list of authors in SMAC). Adjuvant chemotherapy for localised resectable soft tissue sarcoma in adults. Cochrane Database Syst Rev. 2000;(4):CD001419.
• Tierney JF, Mosseri V, Stewart LA, Souhami RL, Parmar MK. Adjuvant chemotherapy for soft-tissue sarcoma: review and meta-analysis of the published results of randomised clinical trials. Br J Cancer 1995 Aug;72(2):469-75. [PubMed] [DARE]