title: Effect of amifostine on survival among patients treated with radiotherapy: a meta-analysis of individual patient data.
abstract: OBJECTIVE
  Controversy exists regarding whether or not amifostine might reduce the efficacy of cancer treatment. The aim of this meta-analysis was to evaluate the impact of amifostine on overall survival (OS) and progression-free survival (PFS) in patients treated with radiotherapy or chemoradiotherapy.
  
  
  METHODS
  Updated data from individual patients with non-small-cell lung cancer, head and neck squamous cell carcinoma, and pelvic cancer treated with radiotherapy or chemoradiotherapy and randomly assigned to amifostine or not were included. The primary end point was OS.
  
  
  RESULTS
  Twenty-two randomized trials (2279 patients) were potentially eligible. Data were available for 16 trials (1554 patients), but four trials (435 patients) were excluded after data checking. Ultimately 12 trials and 1119 patients were analyzed. A total of 431 patients were treated with radiotherapy alone (three trials), and 688 patients were treated with chemoradiotherapy (nine trials). Thirty-three percent of patients had lung cancers, 65% had head and neck cancers, and 2% had pelvic carcinomas. Ninety-one percent of patients had locally advanced disease (early stage, 9%). Median follow-up was 5.2 years. The hazard ratio (HR) of death was 0.98 (95% CI, 0.84 to 1.14; P = .78). On the basis of 11 trials (1091 patients), the HR of progression, relapse, or death was 1.05 (95% CI, 0.90 to 1.22; P = .53). The tests for heterogeneity were not significant (P ≥ .73), and there was no significant variation of treatment effect according to sex, age, tumor site, stage, histology, locoregional treatment, or type of administration for either end point.
  
  
  CONCLUSIONS
  Amifostine did not reduce OS and PFS in patients treated with radiotherapy or chemoradiotherapy.
authors.affiliation: Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif Cedex, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Bourhis
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanchard
authors.forename: Emilie
authors.initials: E
authors.lastname: Maillard
authors.forename: David M
authors.initials: DM
authors.lastname: Brizel
authors.forename: Benjamin
authors.initials: B
authors.lastname: Movsas
authors.forename: Jens
authors.initials: J
authors.lastname: Buentzel
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Swan
authors.initials: S
authors.lastname: Swan Leong
authors.forename: Peter
authors.initials: P
authors.lastname: Levendag
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Pignon
mesh_terms: D000328:Adult; D000368:Aged; D004999:Amifostine / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011837:Radiation-Protective Agents / Q000627:therapeutic use*; D011878:Radiotherapy / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy
chemical_list: D011837:Radiation-Protective Agents; D004999:Amifostine