Dose-intensive versus dose-control chemotherapy for high-grade osteosarcoma: a meta-analysis

Tumor necrosis might be a consequence of innate sensitivity of tumor cells to changed dosage instead of the increased dosage of chemotherapeutics in the treatment of osteosarcoma patients.

To explore whether dose-intensive regimen was a better treatment method than dose-control chemotherapy for high-grade osteosarcoma patients.

The data of the included studies was analyzed by random-effects model when there was heterogeneity, otherwise by fixed-effects method. Meta-analysis outcomes were calculated as risk ratio (RR) and 95% confidence interval (CI) for 5-year disease free survival rate, 5-year overall survival, local recurrence rate, good histological response rate and Limb salvage rate.

Five studies involving 1434 patients with high-grade osteosarcoma were included. All the included studies were inadequate in the information about randomization and blinding method. The meta-analysis showed that there was no significant difference between the dose-intensive group and the dose control group in 5-year disease free survival rate (RR: 1.08, 95% CI: 0.96-1.21), 5-year overall survival rate (RR: 1.07, 95% CI: 0.98-1.17), good histological response rate (RR: 1.08, 95% CI: 0.82-1.43), limb salvage rate (RR: 0.97, 95% CI: 0.93-1.02). However, the local recurrence rate (RR: 0.65, 95% CI: 0.46- 0.92) and the 5-year disease free survival rate of the good and poor histological response (RR: 1.57, 95% CI: 1.36- 1.82) were significantly different.

Dose-intensive regimen might not be a preferred treatment for all of the high-grade osteosarcoma patients. Although there were advantages in dose-intensive regimen, appropriate dosage of chemotherapy should be considered in clinical cases.