Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin's disease. International Database on Hodgkin's Disease Overview Study Group.

2.50
Hdl Handle:
http://hdl.handle.net/10541/91890
Title:
Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin's disease. International Database on Hodgkin's Disease Overview Study Group.
Authors:
Loeffler, M; Brosteanu, O; Hasenclever, D; Sextro, Michael; Assouline, D; Bartolucci, A A; Cassileth, P A; Crowther, Derek; Diehl, Volker; Fisher, R I; Hoppe, R T; Jacobs, P; Pater, J L; Pavlovsky, S; Thompson, E; Wiernik, Peter H
Abstract:
DESIGN: To perform a meta-analysis of all randomized trials that compared chemotherapy (CT) alone versus combined modality treatment (CT + radiotherapy [RT]) for which individual patient data could be made available. PATIENTS AND METHODS: Data on 1,740 patients treated on 14 different trials that included 16 relevant comparisons have been analysed. Eight comparisons were designed to evaluate the benefit of additional RT after the same CT (CT1 v CT1 + RT; additional RT design). Eight comparisons were designed to evaluate whether RT in a combined modality setting can be substituted by CT using either more cycles of the same CT or regimens that contain additional drugs (CT1 + CT2 v CT1 + RT or CT1 v CT2 + RT; parallel RT/CT design). RESULTS: Additional RT showed an 11% overall improvement in tumor control rate after 10 years (P = .0001; 95% confidence interval [CI], 4% to 18%). No difference could be detected with respect to overall survival (P = .57; 95% CI, -10% to 4%). In contrast, when combined modality treatment was compared with CT alone in the parallel-design trials, no difference could be detected in tumor control rates (P = .43; 95% CI, -6% to 9%), but overall survival was significantly better after 10 years in the group that did not receive RT (P = .045; 8% difference; 95% CI, 1% to 15%). There were significantly fewer fatal events among patients in continuous complete remission (relative risk [RR], 1.73; 95% CI, 1.17 to 2.53; P = .005) if no RT was given. CONCLUSION: Combined modality treatment in patients with advanced-stage Hodgkin's disease overall has a significantly inferior long-term survival outcome than CT alone if CT is given over an appropriate number of cycles. The role of RT in this setting is limited to specific indications.
Affiliation:
Institute for Medical Informatics, Statistics and Epidemiology, Leipzig, Germany. loeffler@imise.uni-leipzig.de
Citation:
Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin's disease. International Database on Hodgkin's Disease Overview Study Group. 1998, 16 (3):818-29 J. Clin. Oncol.
Journal:
Journal of Clinical Oncology
Issue Date:
Mar-1998
URI:
http://hdl.handle.net/10541/91890
PubMed ID:
9508162
Type:
Article
Language:
en
ISSN:
0732-183X
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorLoeffler, Men
dc.contributor.authorBrosteanu, Oen
dc.contributor.authorHasenclever, Den
dc.contributor.authorSextro, Michaelen
dc.contributor.authorAssouline, Den
dc.contributor.authorBartolucci, A Aen
dc.contributor.authorCassileth, P Aen
dc.contributor.authorCrowther, Dereken
dc.contributor.authorDiehl, Volkeren
dc.contributor.authorFisher, R Ien
dc.contributor.authorHoppe, R Ten
dc.contributor.authorJacobs, Pen
dc.contributor.authorPater, J Len
dc.contributor.authorPavlovsky, Sen
dc.contributor.authorThompson, Een
dc.contributor.authorWiernik, Peter Hen
dc.date.accessioned2010-02-11T16:44:43Z-
dc.date.available2010-02-11T16:44:43Z-
dc.date.issued1998-03-
dc.identifier.citationMeta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin's disease. International Database on Hodgkin's Disease Overview Study Group. 1998, 16 (3):818-29 J. Clin. Oncol.en
dc.identifier.issn0732-183X-
dc.identifier.pmid9508162-
dc.identifier.urihttp://hdl.handle.net/10541/91890-
dc.description.abstractDESIGN: To perform a meta-analysis of all randomized trials that compared chemotherapy (CT) alone versus combined modality treatment (CT + radiotherapy [RT]) for which individual patient data could be made available. PATIENTS AND METHODS: Data on 1,740 patients treated on 14 different trials that included 16 relevant comparisons have been analysed. Eight comparisons were designed to evaluate the benefit of additional RT after the same CT (CT1 v CT1 + RT; additional RT design). Eight comparisons were designed to evaluate whether RT in a combined modality setting can be substituted by CT using either more cycles of the same CT or regimens that contain additional drugs (CT1 + CT2 v CT1 + RT or CT1 v CT2 + RT; parallel RT/CT design). RESULTS: Additional RT showed an 11% overall improvement in tumor control rate after 10 years (P = .0001; 95% confidence interval [CI], 4% to 18%). No difference could be detected with respect to overall survival (P = .57; 95% CI, -10% to 4%). In contrast, when combined modality treatment was compared with CT alone in the parallel-design trials, no difference could be detected in tumor control rates (P = .43; 95% CI, -6% to 9%), but overall survival was significantly better after 10 years in the group that did not receive RT (P = .045; 8% difference; 95% CI, 1% to 15%). There were significantly fewer fatal events among patients in continuous complete remission (relative risk [RR], 1.73; 95% CI, 1.17 to 2.53; P = .005) if no RT was given. CONCLUSION: Combined modality treatment in patients with advanced-stage Hodgkin's disease overall has a significantly inferior long-term survival outcome than CT alone if CT is given over an appropriate number of cycles. The role of RT in this setting is limited to specific indications.en
dc.language.isoenen
dc.subject.meshAntineoplastic Agents-
dc.subject.meshCombined Modality Therapy-
dc.subject.meshHodgkin Disease-
dc.subject.meshHumans-
dc.subject.meshMultivariate Analysis-
dc.subject.meshRandomized Controlled Trials as Topic-
dc.subject.meshSurvival Analysis-
dc.titleMeta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin's disease. International Database on Hodgkin's Disease Overview Study Group.en
dc.typeArticleen
dc.contributor.departmentInstitute for Medical Informatics, Statistics and Epidemiology, Leipzig, Germany. loeffler@imise.uni-leipzig.deen
dc.identifier.journalJournal of Clinical Oncologyen

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