Concurrent Chemoradiotherapy Compared With Neoadjuvant Chemotherapy Followed by Radical Hysterectomy for FIGO Stage IIB Cervical Cancer Patients: A Systematic Review and Meta-analysis [ID 2683429

Abstract

INTRODUCTION: Cervical cancer is the fourth most common malignant disease and cause of cancer death in women worldwide. FIGO stage IIB includes cervical carcinomas with invasion of the parametria. Despite innovative treatment approaches, recurrence and mortality rates among patients with locally advanced cervical cancer (LACC) have not been significantly reduced. The current treatment recommendation for FIGO stage IIB is concurrent chemoradiotherapy (CCRT). Neoadjuvant chemotherapy followed by radical hysterectomy (NACT+HE) represents a valid alternative. METHODS: According to the PRISMA guidelines and Cochrane handbook recommendations, we systematically searched the following databases up to January 2023: PubMed, Scopus, Web of Science, and Cochrane CENTRAL for relevant studies and reports that compare NACT+HE versus CCRT for patients with LACC and specifically with FIGO stage IIB. RESULTS: Our search results revealed 1,034 records, of them only 6 studies (n=2,055); 2 clinical trials and 4 observational cohorts were eligible to be included in both qualitative and quantitative analyses. Patients with FIGO stage IB2–IVA showed no advantage for 5-year overall survival (OS), disease-free survival (DFS), or progression-free survival (PFS) with NACT+HE compared to CCRT (hazard ratio [HR] 0.66 [95% CI: 0.43–1.01]; HR 0.62 [95% CI: 0.23–1.65]; and HR 0.88 [95% CI: 0.51–1.50]). A subgroup analysis for patients with FIGO stage IIB showed a significantly better 5-year DFS for CCRT compared to NACT+HE (HR 1.86 [95% CI: 1.23–2.81]); however, no significant improvement was shown for 5-year OS and 5-year PFS (HR 0.88 [95% CI: 0.52–1.49] and HR 0.85 [95% CI: 0.56–1.29]), respectively. CONCLUSION: This meta-analysis did not show any advantage for women with LACC treated with the NACT+HE approach compared to those treated with the CCRT approach. However, in a stage-specific analysis of patients with FIGO stage IIB cervical cancer, CCRT was superior to NACT+HE in terms of DFS, whereas no significant difference was shown for OS or PFS.