A Cochrane review [Abstract] 1 [withdrawn from publication] included 47 trials with a total of about 18,000 subjects on prolonged polychemotherapy versus no chemotherapy, 11 trials with a total of about 6000 subjects on longer versus shorter polychemotherapy, and 11 trials with a total of about 6000 subjects on anthracycline-containing regiments versus CMF (cyclophosphamide, methotrexate, and fluorouracil). Polychemotherapy substantially and highly significantly reduced recurrence by 35% and mortality by 27% among women under 50 at randomisation, and by 20% and 11% in women aged 50 - 69 at randomisation. The recurrence reductions emerged chiefly during the first 5 years, whereas the difference in survival grew throughout the firs 10 years. After standardisation for age and time since randomisation, the proportional reductions in risk were similar for women with node-negative and node-positive disease. Applying the proportional mortality reduction observed in all women aged under 50 at randomisation would typically change a 10-year survival of 71% for those with node-negative disease to 78% (an absolute benefit of 7%), and of 42% for those with node-positive disease to 53% (an absolute benefit of 11%). For women aged 50 - 69 a randomisation the corresponding benefits were 2% and 3%. The anthracycline-containing regimens studied produced somewhat greater effects on recurrence and mortality.
Comment: The adverse effects of polychemotherapy were not assessed in this systematic review.
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