Adjuvant chemotherapy in localized, resectable extremity and truncal soft tissue sarcoma and survival outcomes – A systematic review and meta-analysis of randomized controlled trials

Abstract

Introduction

The role of adjuvant chemotherapy in localized, resectable soft tissue sarcomas (STSs) remains controversial. Despite positive findings reported in previous meta-analyses, the majority of randomized controlled trials (RCTs) fail to show a meaningful benefit. We conducted an updated meta-analysis to reassess the role of adjuvant chemotherapy in treating localized, resectable STSs.

Methods

A comprehensive literature review was conducted to identify RCTs that compared local therapy (surgery with or without radiotherapy) to local therapy with adjuvant chemotherapy. Articles were independently reviewed, and risk of bias was assessed by two authors. The outcomes assessed were overall survival (OS) and disease-free survival (DFS). The meta-analysis was performed using a random effects model (to account for possible heterogeneity across studies) for survival endpoints with the inverse-variance method, in which each study is weighted with the inverse of the variance of its effect estimate.

Results

A total of 19 RCTs comprising 2128 patients were included. Our study found that adjuvant chemotherapy improved OS (hazard ratio [HR], 0.80; p = .002) and DFS (HR, 0.78; p = .002). Doxorubicin-based monotherapy significantly improved OS (HR, 0.80; p = .01) and DFS (HR, 0.74; p = .0003), whereas doxorubicin-ifosfamide combined therapy did not significantly improve OS (HR, 0.78; p = .078) or DFS (HR, 0.94; p = .770). Doxorubicin-based ifosfamide combined therapy had moderate heterogeneity across studies.

Conclusion

This study partially supports the benefit of adjuvant chemotherapy in the treatment of localized, resectable STSs. Nevertheless, because of the heterogeneity of STSs, the benefit and the risks of treatment with adjuvant chemotherapy need to be evaluated on an individual benefit–risk basis.