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Meta-Analysis
. 2020 Jul 27:2020:7415056.
doi: 10.1155/2020/7415056. eCollection 2020.

Neoadjuvant Chemotherapy Followed by Radical Surgery versus Radiotherapy (with or without Chemotherapy) in Patients with Stage IB2, IIA, or IIB Cervical Cancer: A Systematic Review and Meta-Analysis

Qingjian Ye  1 , Yuebo Yang  1 , Xinran Tang  1 , Jing Li  1 , Xiaomao Li  1 , Yu Zhang  1
Affiliations
Meta-Analysis

Neoadjuvant Chemotherapy Followed by Radical Surgery versus Radiotherapy (with or without Chemotherapy) in Patients with Stage IB2, IIA, or IIB Cervical Cancer: A Systematic Review and Meta-Analysis

Qingjian Ye et al. Dis Markers. .

Abstract

Background: This study was to compare the efficacy and safety between neoadjuvant chemotherapy followed by radical surgery (NACT+RS) and radiotherapy only (RT) or concurrent chemoradiotherapy (CCRT) for treatment of patients with stage IB2, IIA, or IIB cervical cancer.

Method: The electronic databases of PubMed, Embase, and the Cochrane Library were searched to screen relevant studies from their inception to October 2018. Clinical data including overall survival (OS), disease-free survival (DFS), and adverse events were extracted. Egger's test was used to evaluate the publication bias, and sensitivity analysis was conducted to estimate the robustness of results.

Results: Finally, three randomized controlled trials (RCTs) and two case-control studies consisting of 1,275 patients with stage IB2, IIA, or IIB cervical cancer were included in the current study. Overall, pooled results showed no significant differences in OS ((hazard ratio (HR) = 0.603, 95%CI = 0.350 - 1.038) and DFS (HR = 0.678, 95%CI = 0.242 - 1.904) for patients treated with NACT+RS compared with RT only or CCRT, but the subgroup analysis showed that the OS and DFS were significantly longer in the NACT+RS groups than the RT or CCRT group (OS: HR = 0.431, 95%CI = 0.238 - 0.781, p = 0.006; DFS: HR = 0.300, 95%CI = 0.187 - 0.482, p < 0.001) for the population with median follow-up time of more than 60 months. For adverse events, the incidence of thrombocytopenia in the NACT+RS group was significantly higher than that in the RT only or CCRT group (relative risk (RR) = 3.240, 95% CI 1.575-6.662), while the incidence of diarrhea was significantly lower than that in the RT only or CCRT group (RR = 0.452, 95% CI =0.230-0.890).

Conclusion: These findings suggest that the short-term therapeutic effects of the two treatments may be possibly equal for patients with stage IB2-IIB cervical cancer, but the long-term effects for improving OS and DFS may be better using NACT+RS compared with the RT only or CCRT.

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Conflict of interest statement

No potential conflicts of interest were disclosed.

Figures

Figure 1
Figure 1
Flow diagram of the entire research literature.
Figure 2
Figure 2
Risk of bias summary for the five included studies.
Figure 3
Figure 3
Forest plots for the overall survival.
See this image and copyright information in PMC

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References

    1. WHO. World Health Organization Report: comprehensive cervical cancer control: a guide to essential practice. World Health Organization web site, 2006. February 2008, http://www.who.int/reproductive-health/publications/cervical_cancer_gep/.... - PubMed
    1. Ferlay J., Soerjomataram I., Dikshit R., et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer. 2015;136(5):E359–E386. doi: 10.1002/ijc.29210. - DOI - PubMed
    1. Vizcaino A. P., Moreno V., Bosch F. X., et al. International trends in incidence of cervical cancer: II. Squamous-cell carcinoma. International Journal of Cancer. 2000;86(3):429–435. doi: 10.1002/(SICI)1097-0215(20000501)86:3<429::AID-IJC20>3.0.CO;2-D. - DOI - PubMed
    1. Prat J., FIGO Committee on Gynecologic Oncology Staging classification for cancer of the ovary, fallopian tube, and peritoneum. International Journal of Gynaecology and Obstetrics. 2014;124(1):1–5. doi: 10.1016/j.ijgo.2013.10.001. - DOI - PubMed
    1. Monk B. J., Tewari K. S., Koh W. J. Multimodality therapy for locally advanced cervical carcinoma: state of the art and future directions. Journal of Clinical Oncology. 2007;25(20):2952–2965. doi: 10.1200/JCO.2007.10.8324. - DOI - PubMed