Meng Li1, Mengyang Hu1, Yuanjian Wang2, Xingsheng Yang3. 1. Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, 250012, PR China. 2. Huaxi Clinical Medical College of Sichuan University, Jiang'an campus, Chengdu City, Sichuan, PR China. 3. Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, 250012, PR China. Electronic address: xingshengyang@sdu.edu.cn.
Abstract
BACKGROUND: At present, extensive hysterectomy and pelvic lymph node dissection are preferred for early-stage cervical cancer. However, additional adjuvant therapy could be considered if there is a risk for recurrence. Postoperative pelvic radiotherapy plus concurrent platinum-based chemotherapy are recommended for patients with high risk factors. The treatment regimen for patients with intermediate-risk factors, however, remains unclear. We, thus, performed a systematic review and meta-analysis to assess the recurrence-free survival (RFS), overall survival (OS), grade III/IV hematologic toxicity and grade III/IV non-hematologic toxicity in chemoradiotherapy (CRT) versus radiotherapy (RT) groups. METHODS: We systematically searched PubMed, Cochrane, and Embase to identify relevant studies published before November 30, 2018 to compare CRT with RT as a postoperative adjuvant therapy in early-stage cervical cancer patients with intermediate-risk factors. We used Stata (version 14.0) to calculate odds risks (ORs) and 95% confidence intervals (CIs) and pooled data was assessed by the fixed-effects model. RESULTS: Of the 428 identified studies, only 9 were eligible and included in our analysis (CRT: n = 870; RT: n = 932). CRT significantly prolonged RFS (OR = 3.43, 95% CI 2.08-5.67, P = 0.000) and OS (OR = 1.80, 95% CI 1.30-2.50, P = 0.000). The occurrence rate of grade III/IV hematologic toxicity (OR = 16.07, 95% CI 6.47-39.93, P = 0.000) was significantly higher in CRT, while grade III/IV non-hematologic toxicity was ambiguous for CRT and RT with an OR of 1.91 (95% CI 0.95-3.83, P = 0.069). CONCLUSIONS: For early-stage cervical cancer patients with intermediate-risk factors, CRT can dramatically improve RFS and OS compared with RT. Apart from the increase in grade III/IV hematologic toxicity, CRT was well tolerated and accepted treatment for early-stage cervical cancer.
BACKGROUND: At present, extensive hysterectomy and pelvic lymph node dissection are preferred for early-stage cervical cancer. However, additional adjuvant therapy could be considered if there is a risk for recurrence. Postoperative pelvic radiotherapy plus concurrent platinum-based chemotherapy are recommended for patients with high risk factors. The treatment regimen for patients with intermediate-risk factors, however, remains unclear. We, thus, performed a systematic review and meta-analysis to assess the recurrence-free survival (RFS), overall survival (OS), grade III/IV hematologic toxicity and grade III/IV non-hematologic toxicity in chemoradiotherapy (CRT) versus radiotherapy (RT) groups. METHODS: We systematically searched PubMed, Cochrane, and Embase to identify relevant studies published before November 30, 2018 to compare CRT with RT as a postoperative adjuvant therapy in early-stage cervical cancerpatients with intermediate-risk factors. We used Stata (version 14.0) to calculate odds risks (ORs) and 95% confidence intervals (CIs) and pooled data was assessed by the fixed-effects model. RESULTS: Of the 428 identified studies, only 9 were eligible and included in our analysis (CRT: n = 870; RT: n = 932). CRT significantly prolonged RFS (OR = 3.43, 95% CI 2.08-5.67, P = 0.000) and OS (OR = 1.80, 95% CI 1.30-2.50, P = 0.000). The occurrence rate of grade III/IV hematologic toxicity (OR = 16.07, 95% CI 6.47-39.93, P = 0.000) was significantly higher in CRT, while grade III/IV non-hematologic toxicity was ambiguous for CRT and RT with an OR of 1.91 (95% CI 0.95-3.83, P = 0.069). CONCLUSIONS: For early-stage cervical cancerpatients with intermediate-risk factors, CRT can dramatically improve RFS and OS compared with RT. Apart from the increase in grade III/IV hematologic toxicity, CRT was well tolerated and accepted treatment for early-stage cervical cancer.