The efficacy of high-dose versus moderate-dose chemotherapy in treating osteosarcoma: a systematic review and meta-analysis.

Objective: To evaluate whether the efficacy of high-dose chemotherapy in the treatment of primary well-differentiated osteosarcoma is superior to moderate-dose chemotherapy.
Methods: Cochrane systematic review method was used to retrieve literatures from MEDLINE, Embase, OVID, Cochrane Library database of clinical trials, Chinese Biomedical Literature Database CD-ROM, as well as manual searching from "China Oncology", "Chinese Journal of Clinical Oncology", "Cancer" etc. Meta-analysis was performed using the RevMan 5.0 software.
Results: A total of four studies, 937 cases of primary, non-metastatic, well-differentiated limb osteosarcoma patients were enrolled in the study. Meta-analysis results suggested that compared with moderate-dose group, 5-year disease-free survival, 5-year overall survival rate, the local recurrence rate, proportion of histologic response in good status, limb salvage rate showed no significant difference in high-dose chemotherapy group (All P > 0.05); good and poor response of preoperative chemotherapy tumor histologic of 5-year disease-free survival showed statistical difference (RR = 1.55; 95% CI: 1.19-2.00; P = 0.0009).
Conclusion: High-dose chemotherapy for the treatment of primary osteosarcoma is not better than moderate-dose chemotherapy. It is expected that high quality of randomized controlled trials were performed to provide more reliable evidence in the future.