High-dose Versus Moderate-dose Chemotherapy In Treating The Osteosarcoma: A Systematic Review

Objective:To assess effectiveness of high-dose chemotherapy versus moderate-dose chemotherapy in treating the osteosarcoma.Methods:We searched the MEDLINE,EMBASE,OVID database,CBMdisc,Cochrane Library Clinical Trial database,and hand searched the Journal of Chinese Oncology,Journal of Chinese Clinical Oncology,Tumor.The quality of the included studies was evaluated by two reviewers and meta-analysis performed for the results of the homogenous studies. Results:Four studies involving 937 participants related to primary,high grade, nonmetastatic extremity osteosarcoma were included.All included studies were inadequate in reporting randomization and blinding,only one reported allocation concealment,all studies reported the number and the reason of withdraw,and baseline conditions of all studies were compared.Meta-analysis based on included studies showed that there was no advantage in 5-year EFS[RR 1.10,95%CI(0.96,1.25)],5-year OS[RR 1.08,95%CI(0.97,1.20)],Local Recurrence[RR 0.92,95%CI(0.54,1.57)],Proportions of Good Histological Response[RR 0.93,95%CI(0.81,1.07)],Proportions of Limb Salvage [RR 0.97,95%CI(0.92,1.02)]in statistic significance between high-dose group and moderate-dose group protocol.But 5-yaer EFS of good histological response group is better than poor histological group.Conclusions:There is no advantage for high-dose chemotherapy group over moderate-dose group in 5-year EFS,5-year OS,Local Recurrence,Proportions of Good Histological Response and Proportions of Limb Salvage;the histological response to preoperative chemotherapy is an independent prognosis factor in osteosarcoma.Due to risk of selection bias,performance bias and published bias,the evidence is not strong enough to judge whether high-dose chemotherapy is better than moderate-dose chemotherapy in treating osteosarcoma.Our conclusions suggest that larger-scale randomized trials should be performed in future.