Benefits and adverse events in younger versus older patients receiving neoadjuvant chemotherapy for osteosarcoma: findings from a meta-analysis

The LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival. Suitable data sets were identified by a survey of published d...

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Bibliographic Details
Published in:Journal of clinical oncology Vol. 31; no. 18; p. 2303
Main Authors: Collins, Marnie, Wilhelm, Miriam, Conyers, Rachel, Herschtal, Alan, Whelan, Jeremy, Bielack, Stefan, Kager, Leo, Kühne, Thomas, Sydes, Matthew, Gelderblom, Hans, Ferrari, Stefano, Picci, Piero, Smeland, Sigbjørn, Eriksson, Mikael, Petrilli, Antonio Sérgio, Bleyer, Archie, Thomas, David M
Format: Journal Article
Language:English
Published: United States 20.06.2013
Subjects:
Adolescent
Adult
Age Factors
Bone Neoplasms - drug therapy
Bone Neoplasms - surgery
Chemotherapy, Adjuvant - adverse effects
Child
Combined Modality Therapy
Humans
Kaplan-Meier Estimate
Multivariate Analysis
Neoadjuvant Therapy - adverse effects
Neutropenia - chemically induced
Osteosarcoma - drug therapy
Osteosarcoma - surgery
Outcome Assessment, Health Care - statistics & numerical data
Prospective Studies
Regression Analysis
Sex Factors
Thrombocytopenia - chemically induced
Young Adult
ISSN:1527-7755, 1527-7755
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Summary:The LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival. Suitable data sets were identified by a survey of published data reported in PubMed. The final pooled data set comprised 4,838 patients from five international cooperative groups. After accounting for important variables known at study entry such as tumor location and histology, females experienced higher overall survival rates than males (P = .005) and children fared better than adolescents and adults (P = .002). Multivariate landmark analysis following surgery indicated that a higher rate of chemotherapy-induced tumor necrosis was associated with longer survival (P < .001), as was female sex (P = .004) and the incidence of grade 3 or 4 mucositis (P = .03). Age group was not statistically significant in this landmark analysis (P = .12). Females reported higher rates of grade 3 or 4 thrombocytopenia relative to males (P < .001). Children reported the highest rates of grade 3 or 4 neutropenia (P < .001) and thrombocytopenia (P < .001). The achievement of good tumor necrosis was higher for females than for males (P = .002) and for children than for adults (P < .001). These results suggest fundamental differences in the way chemotherapy is handled by females compared with males and by children compared with older populations. These differences may influence survival in a disease in which chemotherapy is critical to overall outcomes.
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ISSN:1527-7755
1527-7755
DOI:10.1200/JCO.2012.43.8598