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Therapeutic interventions for childhood cancer: An umbrella review of randomized evidence
Critical Reviews in Oncology/Hematology ( IF 5.5 ) Pub Date : 2021-07-06 , DOI: 10.1016/j.critrevonc.2021.103414
Georgios Lavasidis 1 , Georgios Markozannes 2 , Orestis A Panagiotou 3 , Nikolaos A Trikalinos 4 , Eleni Th Petridou 5 , Kirsten Voorhies 6 , Evangelia E Ntzani 7
Affiliation  

Treatment advancements in pediatric cancer have improved prognosis, but the strength of supporting evidence has not been thoroughly evaluated. To critically appraise it, we performed an umbrella review of meta-analyses of randomized controlled trials examining the efficacy and safety of therapeutic interventions for pediatric malignancies. Fourteen publications (68 meta-analyses, 31,496 participants) were eligible. Acute lymphoblastic leukemia (ALL) was investigated at most. Substantial heterogeneity was detected in 10 associations, with limited indications for small-study effects and excess-significance bias. The most concrete evidence pertained to the use of methotrexate and vincristine-prednisone pulses for ALL, improving event-free survival. Evidence regarding other cancers was relatively weak. Conclusively, we found few small meta-analyses focusing mainly on ALL. Randomized evidence stemming from adult populations still seems to serve as valuable indirect evidence backup. More randomized evidence and individual patient data meta-analyses are needed to increase certainty and precision in the care of pediatric cancer patients.



中文翻译:

儿童癌症的治疗干预:随机证据的综合评价

儿科癌症的治疗进展改善了预后,但支持证据的强度尚未得到彻底评估。为了批判性地评估它,我们对随机对照试验的荟萃分析进行了综合评价,这些试验检查了儿科恶性肿瘤治疗干预的有效性和安全性。14 篇出版物(68 篇荟萃分析,31,496 名参与者)符合条件。最多研究急性淋巴细胞白血病(ALL)。在 10 个关联中检测到显着的异质性,小型研究效应和超显着性偏倚的适应症有限。最具体的证据涉及使用甲氨蝶呤和长春新碱强的松脉冲治疗 ALL,提高无事件生存率。关于其他癌症的证据相对较弱。最终,我们发现很少有小型荟萃分析主要关注 ALL。来自成年人口的随机证据似乎仍然可以作为有价值的间接证据支持。需要更多随机证据和个体患者数据荟萃分析,以提高儿科癌症患者护理的确定性和精确性。

更新日期:2021-07-20
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