title: Dose-intensive versus dose-control chemotherapy for high-grade osteosarcoma: a meta-analysis.
abstract: BACKGROUND
  Tumor necrosis might be a consequence of innate sensitivity of tumor cells to changed dosage instead of the increased dosage of chemotherapeutics in the treatment of osteosarcoma patients.
  
  
  OBJECTIVE
  To explore whether dose-intensive regimen was a better treatment method than dose-control chemotherapy for high-grade osteosarcoma patients.
  
  
  METHODS
  The data of the included studies was analyzed by random-effects model when there was heterogeneity, otherwise by fixed-effects method. Meta-analysis outcomes were calculated as risk ratio (RR) and 95% confidence interval (CI) for 5-year disease free survival rate, 5-year overall survival, local recurrence rate, good histological response rate and Limb salvage rate.
  
  
  RESULTS
  Five studies involving 1434 patients with high-grade osteosarcoma were included. All the included studies were inadequate in the information about randomization and blinding method. The meta-analysis showed that there was no significant difference between the dose-intensive group and the dose control group in 5-year disease free survival rate (RR: 1.08, 95% CI: 0.96-1.21), 5-year overall survival rate (RR: 1.07, 95% CI: 0.98-1.17), good histological response rate (RR: 1.08, 95% CI: 0.82-1.43), limb salvage rate (RR: 0.97, 95% CI: 0.93-1.02). However, the local recurrence rate (RR: 0.65, 95% CI: 0.46- 0.92) and the 5-year disease free survival rate of the good and poor histological response (RR: 1.57, 95% CI: 1.36- 1.82) were significantly different.
  
  
  CONCLUSIONS
  Dose-intensive regimen might not be a preferred treatment for all of the high-grade osteosarcoma patients. Although there were advantages in dose-intensive regimen, appropriate dosage of chemotherapy should be considered in clinical cases.
authors.affiliation: Department of Orhtopaedic, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. luhuahawk@hotmail.com.
authors.forename: W
authors.initials: W
authors.lastname: Wang
authors.forename: Z-c
authors.initials: ZC
authors.lastname: Wang
authors.forename: H
authors.initials: H
authors.lastname: Shen
authors.forename: J-j
authors.initials: JJ
authors.lastname: Xie
authors.forename: H
authors.initials: H
authors.lastname: Lu
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D006801:Humans; D023821:Limb Salvage; D009336:Necrosis; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D012516:Osteosarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome