Efficacy and safety of chemotherapy with or without ifosfamide in primary osteosarcoma treatment: a systemic review of randomized controlled trials

BACKGROUND:

Currently, osteosarcoma is mainly treated with a combination of methotrexate. cisplatin, doxorubicin and/or ifosfmaide. However, it is still unclear whether ifosfamide should be included in the preoperative chemotherapy. This study is to systemically and comprehensively compare the efficacy and safety of clinical trials with or without ifosfamide in treating pediatric and adult osteosarcoma.

METHODS:

We searched Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and Clinical trial. gov database. In addition, we searched reference lists of relevant articles and conference proceedings databases. Randomized controlled trials (RCTs) or quasi-controlled clinical trials comparing the efficacy and safety of preoperative chemotherapy including ifosfamide to treatment without ifosfamide in treating primary osteosarcoma. Two reviewers independently conducted the study selection. Two reviewers performed the data extraction and analysis independently.

RESULTS:

Compared with regimen without ifosfamide, the regimen which includes ifosfamide in preoperative chemotherapy does not improve the Overall Survival (HR: 0.98, 95%

CIS:

0.91-1.06, P=0.6) and Event-free Survival (RR: 1.05, 95%

CIS:

0.90-1.22, P=0.57). Moreover, the introduction of ifosfamide into the preoperative chemotherapy may lead to higher frequency of toxicity-related events.

CONCLUSIONS:

Given the efficacy and safety, ifosfamide should not be recommended to be included in preoperative chemotherapy for treating primary osteosarcoma.