title: Efficacy and safety of ifosfamide-based chemotherapy for osteosarcoma: a meta-analysis.
abstract: BACKGROUND
  The efficacy of ifosfamide-based chemotherapy in the treatment of osteosarcoma has been investigated; however, results are inconsistent. Therefore, we reviewed the relevant studies and conducted a meta-analysis to assess the efficacy of ifosfamide-based chemotherapy in patients with osteosarcoma.
  
  
  METHODS
  A systematic literature search on PubMed, Embase, and Web of Science databases was performed. Eligible studies were clinical trials of patients with osteosarcoma who received ifosfamide-based chemotherapy. Hazard ratios (HRs) were pooled to compare event-free survival (EFS) and overall survival (OS). Risk ratios (RRs) were pooled to compare good histologic response rates and adverse event incidence. Meta-analysis was performed using a fixed-effects model or a random-effects model according to heterogeneity.
  
  
  RESULTS
  A total of seven randomized controlled trials were included in this meta-analysis. Pooled results showed that ifosfamide-based chemotherapy significantly improved EFS (HR=0.72, 95% confidence interval [CI]: 0.63, 0.82; P=0.000) and OS (HR=0.83, 95% CI: 0.70, 0.99; P=0.034); furthermore, this form of chemotherapy increased good histologic response rate (RR=1.27, 95% CI: 1.10, 1.46; P=0.001). In addition, patients in the ifosfamide group exhibited a significantly higher incidence of fever (RR=2.23, 95% CI: 1.42, 3.50; P=0.000) and required more frequent platelet transfusion (RR=1.92, 95% CI: 1.23, 3.01; P=0.004).
  
  
  CONCLUSIONS
  This meta-analysis confirmed that ifosfamide-based chemotherapy can significantly improve EFS and OS; this chemotherapy can also increase good histologic response rate in patients with osteosarcoma. However, evidence may be limited by potential biases and confounders. Thus, large-scale well-designed randomized controlled trials are needed to verify current findings.
authors.affiliation: Department of Orthopaedics, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, People's Republic of China.
authors.forename: Xiao-Liang
authors.initials: XL
authors.lastname: Fan
authors.affiliation: Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, People's Republic of China.
authors.forename: Guo-Ping
authors.initials: GP
authors.lastname: Cai
authors.affiliation: Department of Orthopaedics, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, People's Republic of China.
authors.forename: Liu-Long
authors.initials: LL
authors.lastname: Zhu
authors.affiliation: Department of Orthopaedics, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, People's Republic of China.
authors.forename: Guo-Ming
authors.initials: GM
authors.lastname: Ding
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D012516:Osteosarcoma / Q000188:drug therapy* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
chemical_list: D007069:Ifosfamide
keywords: chemotherapy; ifosfamide; meta-analysis; osteosarcoma