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Meta-Analysis
. 2022 Nov 22:10:e14420.
doi: 10.7717/peerj.14420. eCollection 2022.

Adjuvant chemoradiotherapy versus chemotherapy or radiotherapy in advanced endometrial cancer: a systematic review and meta-analysis

Hariyono Winarto  1 , Naufal A A Ibrahim  2 , Yan M Putri  2 , Faiqueen D S F Adnan  2 , Eka D Safitri  3
Affiliations
Meta-Analysis

Adjuvant chemoradiotherapy versus chemotherapy or radiotherapy in advanced endometrial cancer: a systematic review and meta-analysis

Hariyono Winarto et al. PeerJ. .

Abstract

Background: Endometrial cancer is one of the most common gynecological cancer in the world. However, the available adjuvant therapies, chemotherapy (CT) and radiotherapy (RT), demonstrated several limitations when used alone. Therefore, we conducted a meta-analysis to investigate the clinical effectiveness of chemoradiotherapy (CRT) based on overall survival (OS) and disease-free survival (DFS).

Methods: A literature search was performed on five databases and one clinical trial registry to obtain all relevant articles. Search for studies was completed on September 9, 2021. A meta-analysis was conducted to determine the overall hazard ratio with the 95% Confidence Interval.

Results: A total of 17 articles with 23,975 patients in the CRT vs RT group and 50,502 patients in the CRT vs CT group were included. The OS Hazard Ratios (HR) of CRT compared to RT was 0.66 (95% CI [0.59-0.75]; P < 0.00001). Compared to CT, the OS HR was 0.70 (95% CI [0.64-0.78]; P < 0.00001). CRT also significantly improved the DFS compared to CT only (HR 0.79, 95% CI [0.64-0.97]; P = 0.02) However, CRT did not improve the DFS compared to RT only, with HR of 0.71 (95% CI [0.46-1.09]; P = 0.12).

Conclusion: Adjuvant CRT can significantly improve OS compared to CT or RT alone and improve the DFS compared to CT alone in patients with advanced endometrial cancer. Further research is needed to identify the optimal CRT regimen, and to whom CRT will be most beneficial.

Keywords: Adjuvant chemoradiotherapy; Adjuvant chemotherapy; Adjuvant radiotherapy; Endometrial cancer; Survival; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Prisma diagram for study selection.
Figure 2
Figure 2. Forest plot for (A) overall survival dan (B) disease-free survival, chemoradiotherapy vs radiotherapy alone in advanced endometrial cancer.
Figure 3
Figure 3. Forest plot for (A) overall survival and (B) disease-free survival, chemoradiotherapy vs chemotherapy alone in advanced endometrial cancer.
See this image and copyright information in PMC

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