Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment in over half of the trials) and by imprecise results (limited study size for each comparison).
A Cochrane review [Abstract] 1 included 8 studies with a total of 1 644 subjects to assess the effectiveness and toxicity of maintenance chemotherapy for epithelial ovarian cancer. Maintenance chemotherapy was defined as therapy given after complete clinical response (CCR) or complete pathological response (PCR) was achieved.
When all chemotherapy regimens (platinum agents, doxorubicin or paclitaxel with the intended number of courses from three to six) were combined, meta-analysis indicated no significant difference in three-, five- and 10-year overall survival (OS) or progression-free survival (PFS). For five-year OS, the combined risk ratio (RR) was 1.03 (95% CI 0.96 to 1.10; 4 trials, n=899) and for the five-year PFS, the combined RR was 1.06 (95% CI 0.97 to 1.17; 3 trials, n=761). Results were very similar when trials of different regimens were analysed. Comparing chemotherapy with radiotherapy, only the RR for 10-year PFS in pathological complete remission (PCR) was in favour of whole abdominal radiotherapy 0.51 (95% CI 0.27 to 1.00), while three- and five-year OS rates have no significant difference between the two groups.There is no evidence to suggest that the use of platinum agents, doxorubicin or paclitaxel used as maintenance chemotherapy is more effective than observation alone. The impact of maintenance chemotherapy on QoL was not adressed.
Date of latest search: 21 November 2012
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