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Review
. 2017 Jan;96(2):e5853.
doi: 10.1097/MD.0000000000005853.

Efficacy and toxicity of different concurrent chemoradiotherapy regimens in the treatment of advanced cervical cancer: A network meta-analysis

Zhan-Zhao Fu  1 , Kun Li, Yong Peng, Yue Zheng, Li-Yan Cao, Yun-Jie Zhang, Yong-Mei Sun
Affiliations
Review

Efficacy and toxicity of different concurrent chemoradiotherapy regimens in the treatment of advanced cervical cancer: A network meta-analysis

Zhan-Zhao Fu et al. Medicine (Baltimore). 2017 Jan.

Abstract

Objective: The aim of this study was to compare the efficacy and toxicity of different concurrent chemoradiotherapy (CCRT) regimens in the treatment of advanced cervical cancer (CC) by adopting a network meta-analysis.

Methods: We searched PubMed and Cochrane Library from the inception of these databases to September 2016, and all cohort studies (CSs) related to different CCRT regimens in the treatment of CC were included. A network analysis was adopted to compare the combination of direct and indirect evidence, to analyze the odds ratio (OR), and to draw a surface under the cumulative ranking curve of the efficacy and toxicity of different CCRT regimens for CC. Cluster analyses were used to group each category based on similar treatment regimens.

Results: Nineteen CSs were enrolled in this network meta-analysis, including 12 CCRT regimens (radiotherapy [RT], CCRT [cisplatin], CCRT [vinorelbine], CCRT [paclitaxel], CCRT [hydroxyurea], CCRT [cisplatin + FU], CCRT [cisplatin + gemcitabine], CCRT [cisplatin + docetaxel], CCRT [cisplatin + paclitaxel], CCRT [cisplatin + amifostine], CCRT [cisplatin + FU + hydroxyurea], and CCRT [cisplatin + vincristine + bleomycin]). The results of the network meta-analysis showed that regarding efficacy, the overall response rate of CCRT (cisplatin + docetaxel) was higher than RT, and the 5-year overall survival (OS) rate of CCRT (cisplatin + FU + hydroxyurea) was relatively higher than CCRT (hydroxyurea). As for toxicity, CCRT (cisplatin) had a lower incidence of leukopenia than CCRT (hydroxyurea), CCRT (cisplatin + FU) and CCRT (cisplatin + paclitaxel), and the incidences of diarrhea and vomiting in CCRT (cisplatin) were lower than those in CCRT (cisplatin + gemcitabine). Additionally, the cluster analysis showed that CCRT (cisplatin) had relatively lower incidences of both hematotoxicity and gastrointestinal toxicity, and CCRT (paclitaxel) had lower gastrointestinal toxicity than other regimens.

Conclusion: Our study demonstrated that CCRT (cisplatin + docetaxel) might be the best choice of CCRT regimens in the treatment of CC, and the 5-year OS rate of CCRT (cisplatin + FU + hydroxyurea) might be the highest among these different regimens. CCRT (cisplatin) might have the lowest toxicity among all the CCRT regimens.

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Conflict of interest statement

The authors declare that there is no conflict of interests.

Figures

Figure 1
Figure 1
Evidence plots of the ORR, OS, and DFS of the 12 CCRT regimens included in this network meta-analysis. CCRT = concurrent chemoradiotherapy, DFS = disease-free survival, ORR = overall response rate, OS = overall survival.
Figure 2
Figure 2
Clustered ranking plots based on SUCRA values of the efficacy (ORR, 5-year OS rate, 5-year DFS rate) and toxicity (anemia, leukopenia, neutropenia, thrombocytopenia, diarrhea, nausea, and vomiting) of the 12 CCRT regimens in the treatment of advanced CC. CCRT = concurrent chemoradiotherapy, DFS = disease-free survival, ORR = overall response rate, OS = overall survival, SUCRA = surface under the cumulative ranking.
Figure 3
Figure 3
Comparison-adjusted funnel plots of the efficacy (ORR, 5-year OS rate and 5-year DFS rate) and toxicity (anemia and leukopenia) of the 12 CCRT regimens. CCRT = concurrent chemoradiotherapy, DFS = disease-free survival, ORR = overall response rate, OS = overall survival.
Figure 4
Figure 4
Comparison-adjusted funnel plots of the toxicity (neutropenia, thrombocytopenia, diarrhea, nausea, and vomiting) of the 12 CCRT regimens in the treatment of advanced CC. CC = cervical cancer, CCRT = concurrent chemoradiotherapy,
See this image and copyright information in PMC

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