The efficacy and safety of neoadjuvant therapy followed by radical surgery versus definite chemoradiotherapy in the treatment of IB2-IIB cervical cancer: a meta-analysis

Abstract

Objective To systematically evaluate the efficacy and safety between neoadjuvant therapy followed by radical surgery and definite chemoradiotherapy in the treatment of ⅠB2-ⅡB cervical cancer. Methods A computerized search was performed in PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang Data, CNKI and VIP to collect controlled clinical trials related to neoadjuvant therapy followed by radical surgery versus definite chemoradiotherapy in the treatment of ⅠB2-ⅡB cervical cancer. The meta-analysis of survival data and adverse events was performed by Review Manager 5.3 software. Results Nine controlled clinical trials involving 3 914 patients were included in this meta-analysis. There were no significant differences in overall survival (HR=0.83, P=0.31) and progression-free survival (HR=0.85, P=0.57) between two groups. Compared with patients receiving definite chemoradiotherapy, those in the neoadjuvant therapy group had a significantly lower risk of irradiation enteritis (RR=0.27, P=0.03), whereas no significant difference was observed in the risk of irradiation cystitis (RR=0.30, P=0.34) and grade ≥3 neutropenia (RR=0.77, P=0.46) between two groups. Conclusion In the treatment of locally advancedⅠB2-ⅡB cervical cancer, two modalities show similar survival benefits. Although the neoadjuvant therapy group yields a lower incidence of irradiation enteritis, the incidence rates of irradiation cystitis and grade ≥3 neutropenia do not significantly differ between two groups. Neoadjuvant therapy followed by radical surgery is not superior to the standard therapeutic regime. Key words: Cervical neoplasm/surgery; Cervical neoplasm/concurrent radiochemotherapy; Prognosis; Meta-analysis