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Meta-Analysis
. 2010 Mar 17;2010(3):CD006377.
doi: 10.1002/14651858.CD006377.pub3.

Combined use of hyperthermia and radiation therapy for treating locally advanced cervix carcinoma

Ludy Lutgens  1 , Jacoba van der Zee, Madelon Pijls-Johannesma, Danielle Fm De Haas-Kock, Jeroen Buijsen, Ghislaine Apg van Mastrigt, Guido Lammering, Dirk K M De Ruysscher, Philippe Lambin
Affiliations
Meta-Analysis

Combined use of hyperthermia and radiation therapy for treating locally advanced cervix carcinoma

Ludy Lutgens et al. Cochrane Database Syst Rev. .

Abstract

Background: Hyperthermia is a type of cancer treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells. It was introduced into clinical oncology practice several decades ago. Positive clinical results, mostly obtained in single institutions, resulted in clinical implementation albeit in a limited number of cancer centres worldwide. Because large scale randomised clinical trials (RCTs) are lacking, firm conclusions cannot be drawn regarding its definitive role as an adjunct to radiotherapy in the treatment of locally advanced cervix carcinoma (LACC).

Objectives: To assess whether adding hyperthermia to standard radiotherapy for LACC has an impact on (1) local tumour control, (2) survival and (3) treatment related morbidity.

Search strategy: The electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), (Issue 1, 2009) and Cochrane Gynaecological Cancer Groups Specialised Register, MEDLINE, EMBASE, online databases for trial registration, handsearching of journals and conference abstracts, reviews, reference lists, and contacts with experts were used to identify potentially eligible trials, published and unpublished until January 2009.

Selection criteria: RCTs comparing radiotherapy alone (RT) versus combined hyperthermia and radiotherapy (RHT) in patients with LACC.

Data collection and analysis: Between 1987 and 2009 the results of six RCTs were published, these were used for the current analysis.

Main results: 74% of patients had FIGO stage IIIB LACC. Treatment outcome was significantly better for patients receiving the combined treatment (Figures 4 to 6). The pooled data analysis yielded a significantly higher complete response rate (relative risk (RR) 0.56; 95% confidence interval (CI) 0.39 to 0.79; p < 0.001), a significantly reduced local recurrence rate (hazard ratio (HR) 0.48; 95% CI 0.37 to 0.63; p < 0.001) and a significantly better overall survival (OS) following the combined treatment with RHT(HR 0.67; 95% CI 0.45 to 0.99; p = 0.05). No significant difference was observed in treatment related acute (RR 0.99; 95% CI 0.30 to 3.31; p = 0.99) or late grade 3 to 4 toxicity (RR 1.01; CI 95% 0.44 to 2.30; p = 0.96) between both treatments.

Authors' conclusions: The limited number of patients available for analysis, methodological flaws and a significant over-representation of patients with FIGO stage IIIB prohibit drawing definite conclusions regarding the impact of adding hyperthermia to standard radiotherapy. However, available data do suggest that the addition of hyperthermia improves local tumour control and overall survival in patients with locally advanced cervix carcinoma without affecting treatment related grade 3 to 4 acute or late toxicity.

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Conflict of interest statement

none

Figures

1
1
Search Flow
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
4
4
Forest plot of comparison: 1 RT + HT versus RT: all studies, outcome: 1.1 complete tumour response.
5
5
Forest plot of comparison: 1 RT + HT versus RT: all studies, outcome: 1.2 local tumour recurrence_HR.
6
6
Forest plot of comparison: 1 RT + HT versus RT: all studies, outcome: 1.3 overall survival_HR.
7
7
Forest plot of comparison: 1 RT + HT versus RT: all studies, outcome: 1.7 toxicity (acute and late).
1.1
1.1. Analysis
Comparison 1: RT + HT versus RT: all studies, Outcome 1: complete tumour response
1.2
1.2. Analysis
Comparison 1: RT + HT versus RT: all studies, Outcome 2: local tumour recurrence_HR
1.3
1.3. Analysis
Comparison 1: RT + HT versus RT: all studies, Outcome 3: overall survival_HR
1.4
1.4. Analysis
Comparison 1: RT + HT versus RT: all studies, Outcome 4: toxicity (acute and late)
8
8
Abbreviations
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD006377.pub2

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References

References to studies included in this review

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RADCHOC {unpublished data only}
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