Sean Kehoe and colleagues compared chemotherapy then surgery versus surgery then chemotherapy in a landmark trial of 552 women with advanced cancer of the ovary. Though not reaching significance on the frequentist test, there was a 13% advantage for the chemo-first protocol. In addition less surgical deaths were recorded in the chemo-first group, this time at a high level of statistical significance. We have compared adjuvant chemotherapy versus no adjuvant chemotherapy across all cancers, showing that the hypothesis of a similar effect across all cancers is better supported than the hypothesis of different effects by cancer type. It would be fascinating to compare chemotherapy versus surgery first trials in a multiple-indication review  across all cancers. Any takers?
— Richard Lilford, CLAHRC WM Director
- Kehoe S, Hook J, Nankivell M, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet. 2015; 386: 249-57.
- Bowater RJ, Abdelmalik SM, Lilford RJ. Efficacy of adjuvant chemotherapy after surgery when considered over all cancer types: a synthesis of meta-analyses. Ann Surg Oncol. 2012;19(11):3343-50.
- Chen YF, Hemming K, Chilton PJ, Gupta KK, Altman DG, Lilford RJ. Scientific hypotheses can be tested by comparing the effects of one treatment over many diseases in a systematic review. J Clin Epidemiol. 2014;67(12):1309-19.