Abstract
Background This study was to compare the efficacy and safety between neoadjuvant chemotherapy followed by radical surgery (NACT+RS) and radiotherapy only (RT) or concurrent chemoradiotherapy (CCRT) for treatment of patients with stage IB2, IIA, or IIB cervical cancer. Method The electronic databases of PubMed, Embase, and the Cochrane Library were searched to screen relevant studies from their inception to October 2018. Clinical data including overall survival (OS), disease-free survival (DFS), and adverse events were extracted. Egger's test was used to evaluate the publication bias, and sensitivity analysis was conducted to estimate the robustness of results. Results Finally, three randomized controlled trials (RCTs) and two case-control studies consisting of 1,275 patients with stage IB2, IIA, or IIB cervical cancer were included in the current study. Overall, pooled results showed no significant differences in OS ((hazard ratio (HR) = 0.603, 95%CI = 0.350 − 1.038) and DFS (HR = 0.678, 95%CI = 0.242 − 1.904) for patients treated with NACT+RS compared with RT only or CCRT, but the subgroup analysis showed that the OS and DFS were significantly longer in the NACT+RS groups than the RT or CCRT group (OS: HR = 0.431, 95%CI = 0.238 − 0.781, p = 0.006; DFS: HR = 0.300, 95%CI = 0.187 − 0.482, p < 0.001) for the population with median follow-up time of more than 60 months. For adverse events, the incidence of thrombocytopenia in the NACT+RS group was significantly higher than that in the RT only or CCRT group (relative risk (RR) = 3.240, 95% CI 1.575-6.662), while the incidence of diarrhea was significantly lower than that in the RT only or CCRT group (RR = 0.452, 95% CI =0.230-0.890). Conclusion These findings suggest that the short-term therapeutic effects of the two treatments may be possibly equal for patients with stage IB2-IIB cervical cancer, but the long-term effects for improving OS and DFS may be better using NACT+RS compared with the RT only or CCRT.
Highlights
Cervical cancer is the second most common malignant tumor in women and has become a major public health problem worldwide [1, 2]
Advanced cervical cancer (LACC) is defined as IB2-IIB stages according to the International Federation of Gynecology and Obstetrics (FIGO) staging system [4], treatment of which may reduce the risk of progression and subsequent death [5, 6]
The summary results, which indicated that the results of this study were robust (Supplemental figure 2). This meta-analysis compared the efficacy of Neoadjuvant chemotherapy (NACT)+radical surgery (RS) with RT or concurrent chemoradiotherapy (CCRT) for patients with stage IB2-IIB cervical cancer by summarizing the results of five studies
Summary
Cervical cancer is the second most common malignant tumor in women and has become a major public health problem worldwide [1, 2]. This study was to compare the efficacy and safety between neoadjuvant chemotherapy followed by radical surgery (NACT+RS) and radiotherapy only (RT) or concurrent chemoradiotherapy (CCRT) for treatment of patients with stage IB2, IIA, or IIB cervical cancer. Overall, pooled results showed no significant differences in OS ((hazard ratio ðHRÞ = 0:603, 95%CI = 0:350 − 1:038) and DFS (HR = 0:678, 95% CI = 0:242 − 1:904) for patients treated with NACT+RS compared with RT only or CCRT, but the subgroup analysis showed that the OS and DFS were significantly longer in the NACT+RS groups than the RT or CCRT group (OS: HR = 0:431, 95%CI = 0:238 − 0:781, p = 0:006; DFS: HR = 0:300, 95%CI = 0:187 − 0:482, p < 0:001) for the population with median follow-up time of more than 60 months. These findings suggest that the short-term therapeutic effects of the two treatments may be possibly equal for patients with stage IB2-IIB cervical cancer, but the long-term effects for improving OS and DFS may be better using NACT+RS compared with the RT only or CCRT
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
