Chemotherapy for high-grade XXXX .

@entity1 @entity5 @entity900 @entity11 @entity204
BACKGROUND: Trials on the effect of systemic chemotherapy on survival and recurrence in adults with high-grade @entity11 have had inconclusive results. We undertook a systematic review and meta-analysis to assess the effects of such treatment on survival and recurrence. OBJECTIVES: To compare radiotherapy plus chemotherapy with radiotherapy alone in completely resected adults with high-grade @entity11 . To investigate whether or not pre-defined @entity1 subgroups benefit more or less from chemotherapy. SEARCH STRATEGY: MEDLINE and CancerLit searches were supplemented with information from trial registers and by hand searching relevant meeting proceedings and by discussion with relevant trialists and organisations. These searches were carried out in June 1997, June 1999 and December 2000. SELECTION CRITERIA: Trials comparing radiotherapy versus radiotherapy + chemotherapy were eligible for inclusion provided that they randomized adult @entity1 using a method which precluded prior knowledge of treatment assignment. DATA COLLECTION AND ANALYSIS: A quantitative meta-analysis using updated information from individual @entity1 from all available randomized trials was carried out. Data from all @entity1 randomized in all eligible trials were sought directly from those responsible. Updated information on survival and date of follow-up were obtained, as were details of treatment allocation, date of randomization, age, sex, histological cell type, stage and performance status. To avoid potential bias, information was requested for all randomized @entity1 including those who had been excluded from the investigators' original analyses. All analyses were done on an intention to treat basis on the endpoint of survival. For trials using @entity900 -based regimens, subgroup analyses by age, sex, histological cell type, @entity5 stage and performance status were also done. MAIN RESULTS: Data from 12 randomized trials and 3004 @entity1 were included. The results show a significant prolongation of survival associated with chemotherapy, with a hazard ratio of 0.85 (95% CI 0.78-0.91, p=0.00004) or 15% relative decrease in the risk of @entity204 . This is equivalent to an absolute increase in one year survival rate of 6% (95% confidence interval 3% to 9%) from 40% to 46% and a two-month increase in median survival time (95% confidence interval one month to three months). There was no evidence that the effect of chemotherapy was different in any group of @entity1 defined by age, sex, histology, performance status or extent of resection. REVIEWER'S CONCLUSIONS: This small but clear improvement in survival from chemotherapy encourages further study of drug treatment of these tumours
