Osteosarcoma is a bone malignancy that occurs commonly in children and young adolescents. Some studies have shown that ifosfamide in combination with other chemotherapy agents improve prognostic outcomes in patients with high-grade osteosarcoma; however, other study results have concluded that ifosfamide’s efficacy was not significant.
Due to the controversy of ifosfamide’s effects, investigators sought to determine the efficacy of ifosfamide on neoadjuvant chemotherapy for patients with osteosarcoma of the extremity.
The investigators conducted a meta-analysis and systematic review of pooled data from randomized controlled trials, observing the association of ifosfamide therapy with the risk of histological response, survival rate, and other outcomes compared with the neoadjuvant chemotherapy without ifosfamide
There were 1,378 patients included in the meta-analysis. The analysis showed that the use of ifosfamide was not advantageous in the histological response to chemotherapy (cHR; OR 1.36; 95 % CI 0.90-2.03, P = 0.140), 5-year event-free survival (EFS; OR 1.16; 95 % CI 0.789-1.75, P = 0.464), and 5-year overall survival (OS; OR 1.06; 95 % CI 0.70-1.59, P = 0.794); however, there was an improved rate of limb salvage with ifosfamide (OR 4.06; 95 % CI 2.04-8.10, P < 0.001).
Although ifosfamide used in neoadjuvant chemotherapy for extremity osteosarcoma might not be effective for cHR, EFS, and OS, its efficacy to increase the rate of limb salvage suggests that ifosfamide could increase the success rate of limb salvage operation.
The investigators conclude that ifosfamide is an effective therapy method for osteosarcoma, but further studies are necessary to reassess the conclusion and to determine the optimal combination therapy.
The authors performed a meta–analysis based on randomized controlled trials to gather more evidence of the effect of ifosfamide on neoadjuvant chemotherapy for patients with osteosarcoma of the extremity. Neoadjuvant chemotherapy with ifosfamide for patients with extremity osteosarcoma might not increase the cHR and exhibited no significant effect on either EFS or OS.