Abstract
AimThis study aimed to identify the most effective treatment mode for locally advanced cervical cancer (LACC) by adopting a network meta-analysis (NMA).MethodsRandomized controlled trials about treatments were retrieved from PubMed, Medline and Embase. Odds ratios (OR) of overall survival (OS) and progression-free survival (PFS) were calculated by synthesizing direct and indirect evidence to rank the efficacy of nine treatments. Consistency was assessed by node-splitting method. Begg’s test was performed to evaluate publication bias. The surface under cumulative ranking curve (SUCRA) was also used in this NMA.ResultsA total of 24 eligible randomized controlled trials with 6,636 patients were included in our NMA. These trials compared a total of nine different regimens: radiotherapy (RT) alone, surgery, RT plus adjuvant chemotherapy (CT), concurrent chemoradiotherapy (CCRT), neoadjuvant CT plus CCRT, CCRT plus adjuvant CT, neoadjuvant CT, RT, CCRT plus surgery. Among those therapeutic modalities, we found that the two interventions with the highest SUCRA for OS and PFS were CCRT and CCRT plus adjuvant CT, respectively. ORs and 95% confidence interval (CI) for the two best strategies were CCRT versus CCRT plus adjuvant CT (OR, 0.84; 95% CI, 0.53–1.31) for OS, CCRT plus adjuvant CT versus CCRT (OR, 0.60; 95% CI, 0.38–0.96) for PFS.ConclusionsThis NMA supported that CCRT and CCRT plus adjuvant CT are likely to be the most optimal treatments in terms of both OS and PFS for LACC. Future studies should focus on comparing CCRT and CCRT plus adjuvant CT in the treatment of LACC.Systematic Review RegistrationPROSPERO, CRD42019147920.
Highlights
Cervical cancer remains the fourth most common and lethal female malignancy worldwide, with an estimated 569,847 new cases and 311,365 deaths worldwide reported in 2018 [1]
These trials compared a total of nine different regimens: radiotherapy (RT) alone, surgery, RT plus adjuvant chemotherapy (CT), concurrent chemoradiotherapy (CCRT), neoadjuvant CT plus CCRT, CCRT plus adjuvant CT, neoadjuvant CT, RT, CCRT plus surgery
We found that the two interventions with the highest surface under cumulative ranking curve (SUCRA) for overall survival (OS) and progression-free survival (PFS) were CCRT and CCRT plus adjuvant CT, respectively
Summary
Cervical cancer remains the fourth most common and lethal female malignancy worldwide, with an estimated 569,847 new cases and 311,365 deaths worldwide reported in 2018 [1]. Many trials have shown that concurrent chemoradiotherapy (CCRT) reduces the risk of death for LACC by 30 to 50% compared with radiotherapy (RT) alone [5–9]. Based on these data, the National Cancer Institute suggested that strong consideration should be given to using CCRT instead of RT alone for LACC [10]. Surgery is still a common treatment option, and neoadjuvant chemotherapy (CT) before surgery has been shown to improve survival in selected LACC patients [11, 12]. There is much debate because four randomized controlled trials of adjuvant CT after CCRT have inconsistent data when compared with CCRT [15–18]. With lots of neoadjuvant and adjuvant therapies, the optimal strategy for the management of LACC remains to be characterized
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