Abstract

BackgroundCervical cancer is a common malignancy of the female genital tract. Treatment options for cervical cancer patients diagnosed at FIGO (2009) stage IB2 and IIA2 remains controversial.MethodsWe perform a Bayesian network meta-analysis to directly or indirectly compare various interventions for FIGO (2009) IB2 and IIA2 disease, in order to improve our understand of the optimal treatment strategy for these women. Three databases were searched for articles published between 1971 and 2020. Data on included study characteristics, outcomes, and risk of bias were abstracted by two reviewers.ResultsSeven thousand four hundred eighty-six articles were identified. Thirteen randomized controlled trials of FIGO (2009) IB2 and IIA2 cervical cancer patients were included in the final analysis. These trials used six different interventions: concomitant chemoradiotherapy (CCRT), radical surgery (RS), radical surgery following chemoradiotherapy (CCRT+RS), neoadjuvant chemotherapy followed by radical surgery (NACT+RS), adjuvant radiotherapy followed by Radical surgery (RT + RS), radiotherapy alone (RT).SUCRA ranking of OS and Relapse identified CCRT+RS and CCRT as the best interventions, respectively. Systematic clustering analysis identified the CCRT group as a unique cluster.ConclusionThese data suggest that CCRT may be the best approach for improving the clinical outcome of cervical cancer patients diagnosed at FIGO (2009) stage IB2/IIA2. Phase III randomized trials should be performed in order to robustly assess the relative efficacy of available treatment strategies in this disease context.

Highlights

  • Cervical cancer is a major cause of morbidity and mortality, and remains one of the four most common malignant tumors in women

  • * Correspondence: xulin64@163.com †Jing Cheng and Biao Wang contributed to this work. 3Department of Gynecology, Kunming Tongren Hospital, No 1099 Guangfu Road, Xishan District, Kunming City 650100, Yunnan Province, China Full list of author information is available at the end of the article (RS), radical surgery following chemoradiotherapy (CCRT+RS), neoadjuvant chemotherapy followed by radical surgery (NACT+RS), adjuvant radiotherapy followed by Radical surgery (RT + RS), radiotherapy alone (RT)

  • We aim to summarize and analyze the existing evidence to explore the clinical outcome of patients treatment with various regimens, using overall survival (OS) and disease recurrence as primary endpoints, in order to identify the optimal approach for management of locally advanced disease

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Summary

Introduction

Cervical cancer is a major cause of morbidity and mortality, and remains one of the four most common malignant tumors in women. Other investigators have reported that NACT + RS improves the long-term DFS and OS of patients with locally advanced disease [7,8,9]. Other treatment regimens, such as CCRT+RS [10, 11], RT + RS [11, 12], RT [13, 14] and RS [14, 15], remain controversial. Treatment options for cervical cancer patients diagnosed at FIGO (2009) stage IB2 and IIA2 remains controversial

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