Local Treatment of the Primary Tumor for Patients with Metastatic Cancer (PRIME-TX): A Meta-analysis
Abstract
BACKGROUND
Local treatment of the primary tumor for patients with metastases is controversial, and prospective data across many disease sites have conflicting conclusions regarding benefits.
METHODS
A comprehensive search was conducted in PubMed/MEDLINE including randomized controlled trials (RCTs) published in the past fifty years. Inclusion criteria were multi-institutional RCTs of patients with metastatic disease receiving systemic therapy randomized to addition of local treatment to the primary tumor. Two primary outcome measures, overall survival (OS) and progression-free survival (PFS), were quantitatively assessed using random effects and meta-analyses were conducted using the inverse variance method for pooling. Secondary endpoints were qualitatively assessed and included toxicity and patient-reported quality of life. Exploratory analyses were performed by treatment type and volume of disease.
RESULTS
Eleven studies comprising 4,952 patients were included (n=1,558 received radiotherapy, 913 received surgery as primary tumor treatment). OS and PFS were not significantly improved from treatment of the primary (OS: HR 0.91, 95% confidence interval (CI): 0.80-1.05; PFS: HR 0.88, 95%CI: 0.72-1.07). Assessment of primary local treatment modality demonstrated a significant difference in summary effect size on PFS between trials using surgery (HR 1.15, 95%CI 0.99-1.33) as compared to radiotherapy (HR 0.73, 95%CI 0.56-0.96) as the local treatment modality (p=0.005). In low…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,952 participants or records.
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