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Collins M, Wilhelm M, Conyers R, Herschtal A, Whelan J, Bielack S, Kager L, Kühne T, Sydes M, Gelderblom H, Ferrari S, Picci P, Smeland S, Eriksson M, Petrilli AS, Bleyer A, Thomas DM. Benefits and Adverse Events in Younger Versus Older Patients Receiving Neoadjuvant Chemotherapy for Osteosarcoma: Findings From a Meta-Analysis. J Clin Oncol 2013; 31:2303-12. [DOI: 10.1200/jco.2012.43.8598] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival. Patients and Methods Suitable data sets were identified by a survey of published data reported in PubMed. The final pooled data set comprised 4,838 patients from five international cooperative groups. Results After accounting for important variables known at study entry such as tumor location and histology, females experienced higher overall survival rates than males (P = .005) and children fared better than adolescents and adults (P = .002). Multivariate landmark analysis following surgery indicated that a higher rate of chemotherapy-induced tumor necrosis was associated with longer survival (P < .001), as was female sex (P = .004) and the incidence of grade 3 or 4 mucositis (P = .03). Age group was not statistically significant in this landmark analysis (P = .12). Females reported higher rates of grade 3 or 4 thrombocytopenia relative to males (P < .001). Children reported the highest rates of grade 3 or 4 neutropenia (P < .001) and thrombocytopenia (P < .001). The achievement of good tumor necrosis was higher for females than for males (P = .002) and for children than for adults (P < .001). Conclusion These results suggest fundamental differences in the way chemotherapy is handled by females compared with males and by children compared with older populations. These differences may influence survival in a disease in which chemotherapy is critical to overall outcomes.
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Affiliation(s)
- Marnie Collins
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Miriam Wilhelm
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Rachel Conyers
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Alan Herschtal
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Jeremy Whelan
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Stefan Bielack
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Leo Kager
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Thomas Kühne
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Matthew Sydes
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Hans Gelderblom
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Stefano Ferrari
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Piero Picci
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Sigbjørn Smeland
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Mikael Eriksson
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Antonio Sérgio Petrilli
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Archie Bleyer
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - David M. Thomas
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
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