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Eur J Obstet Gynecol Reprod Biol. 2019 Jul;238:1-6. doi: 10.1016/j.ejogrb.2019.04.039. Epub 2019 May 4.

Adjuvant chemoradiotherapy versus radiotherapy in cervical cancer patients with intermediate-risk factors: A systematic review and meta-analysis.

Author information

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.

KEYWORDS:

Cervical cancer; Chemoradiotherapy; Intermediate-risk factors; Radiotherapy

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