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Review
. 2025 Apr 14;17(8):1320.
doi: 10.3390/cancers17081320.

Adjuvant Therapy in "Intermediate-Risk" Early-Stage Cervical Cancer: To Treat or Not to Treat? Systematic Review and Meta-Analysis

Chiara Ripepi  1 , Francesco Cracco  1 , Giuseppe Ricci  1   2 , Luigi Nappi  3 , Stefano Restaino  4 , Giuseppe Vizzielli  5 , Stefania Carlucci  6 , Guglielmo Stabile  3
Affiliations
Review

Adjuvant Therapy in "Intermediate-Risk" Early-Stage Cervical Cancer: To Treat or Not to Treat? Systematic Review and Meta-Analysis

Chiara Ripepi et al. Cancers (Basel). .

Abstract

International guidelines do not take a clear position regarding the management of patients with "intermediate-risk" cervical cancer, and they remain noncommittal on the necessity of adjuvant therapy following radical hysterectomy. To determine if adjuvant therapy after surgery adds benefit in "intermediate-risk" cervical cancer patients in terms of recurrence rate and mortality rate, we performed a systematic review with meta-analysis on Google Scholar, PubMed, and Scopus. The inclusion criteria were studies with >100 patients with intermediate-risk cervical cancer according to the Sedlis criteria, RCTs, or propensity score-matched cohort studies reporting oncological outcomes and treatment-related toxicity, comparing a surgery-only cohort with an adjuvant therapy cohort. We found 11 studies that met our inclusion criteria, comprising a total of 4011 patients. The mean follow-up was 80.7 months. No statistically significant differences were found for both outcomes, respectively, recurrence rate OR 0.92 (95% CI 0.70-1.20, I2 38%) and mortality rate OR 1.05 (95% CI 0.77-1.46, I2 41%). However, a statistically significant difference was found in the site of recurrence-pelvic OR 0.48 (95% CI 0.23-0.98, p < 0.001, I2 42%) or distant OR 2.10 (95% CI 1.02-4.33, p < 0.001 I2 42%). Treatment-related risk of Grade 3 or 4 toxicity was statistically significant. Our meta-analysis shows that oncological outcomes in this class of patients are similar between the two groups. However, while awaiting the results of new RCTs, it is crucial to define a personalized diagnostic and therapeutic strategy for each patient.

Keywords: ajuvant therapy; ater surgery treatment; intermediate-risk early-stage cervical cancer; radiotherapy; surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Total recurrence rate. References: [3,4,8,10,11,12,14,15,16].
Figure 3
Figure 3
Local recurrences. References: [3,7,8,10,11,12].
Figure 4
Figure 4
Distant recurrences. References: [3,7,8,10,11,12].
Figure 5
Figure 5
Mortality Rate. References: [3,7,10,13,15,16].
Figure 6
Figure 6
Treatment-related toxicity Grade 3 or 4. References: [7,9,16].
See this image and copyright information in PMC

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