Ifosfamide-based chemotherapy yields high survival rate for treatment of osteosarcoma

Study Type: Meta analysis
OE Level of Evidence: 1
Journal Level of Evidence: N/A
7 randomized controlled trials with 2,529 patients with histologically confirmed osteosarcoma were included in this meta-analysis. The purpose of this study was to compare the safety and efficacy of ifosfamide-based chemotherapy to a control group receiving chemotherapy without ifosfamide. The results displayed Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
Why was this study needed now?
Osteosarcoma is a malignant tumor of the bone that commonly occurs in the metaphyses of long bones. There is 76% long-term survival rate with modern treatment, which includes multiagent chemotherapy and limb salvage resection. Ifosfamide has been used in combination with chemotherapy to enhance the survival of patients with osteosarcoma and has shown its effectiveness in patients with relapsed or refractory osteosarcoma. However, the results have been debated in the relevant literature, thus, an updated meta-analysis of available studies was warranted.
What was the principal research question?
How safe and efficacious is ifosfamide-based chemotherapy in patients with osteosarcoma?
Data Source: A computerized database search was conducted using PubMed, Embase, and Web of Science up to July 2015. Additionally, abstracts presented at the annual meeting of the American Society of Clinical Oncology and the European Cancer Conference were searched and manual reference lists searches were conducted.
Index Terms: Search strategy included: "osteosarcoma" [MeSH Terms] OR "osteosarcoma" [All Fields] AND "drug therapy" [Subheading] OR "drug" [All Fields] AND "therapy" [All Fields] OR "drug therapy" [All Fields] OR "chemotherapy" [All Fields] OR "drug therapy" [MeSH Terms] OR "drug" [All Fields] AND "therapy" [All Fields] OR "chemotherapy" [All Fields] AND "ifosfamide" [MeSH Terms] OR "ifosfamide" [All Fields].
Study Selection: Inclusion criteria were studies including patients with histologically confirmed osteosarcoma, an experimental group receiving ifosfamide-based chemotherapy, a control group receiving chemotherapy without ifosfamide, and with outcomes including event-free survival, overall survival, good histologic response rate, and toxicity. Two independent reviewers assessed studies for adherence to inclusion criteria, disagreements were resolved by consensus and discussion. 7 randomized controlled trials (RCTs) were selected for inclusion (n=2,529).
Data Extraction: Data was extracted by two independent reviewers.
Data Synthesis: Meta-analyses were conducted using STATA (version 12.0). A fixed-effects model was used when heterogeneity was absent and when heterogeneity was present a random-effects model was used. Heterogeneity was assessed using Cochran's Q chi-square test and I2 statistic (p<0.1 or I2>50% was defined as heterogeneous). The event-free survival and overall survival were treated as time-to-event variables and expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). Good histologic response rate and toxic event incidence were considered dichotomous variables and represented as risk ratios (RRs) with 95% CIs. Publication bias was assessed using the Begg's and Egger's tests. A two-tailed P-value of <0.05 was considered significant.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.