Abstract
Objective The aim of this study was to evaluate the safety and efficacy of intra-arterial versus intravenous neoadjuvant chemotherapy for the management of patients with locally advanced cervical cancer. Methods The PubMed, EMBASE, PMC, Web of Science, and Cochrane databases were searched to identify correlational studies published in English. Prospective controlled studies that evaluated the treatment effect of intra-arterial neoadjuvant chemotherapy or intravenous neoadjuvant chemotherapy in patients with locally advanced cervical cancer were pooled for a meta-analysis. Results A total of three eligible studies with 112 patients with locally advanced cervical cancer were eventually included in this analysis. The baseline regimen of neoadjuvant chemotherapy was platinum-based chemotherapy. The total clinical response rate was 71.4%, and the overall pathological complete response (CR) rate was 11.5%. The grade 3/4 toxicity rate was 27.2%. In the intra-arterial group, the response rate was 83.1% (CR, 22.0%; partial response (PR), 61.0%), which was significantly higher than 58.5% (CR, 11.3%; PR, 47.2%) in the intravenous group (P=0.01). The pathological CR rate was 15.5% in the intra-arterial group, which was higher than 6.5% in the intravenous group. The grade 3/4 toxicity rate was 17.2% in the intra-arterial group, which was higher than the rate of 13.8% in the intravenous group. Conclusion Platinum-based neoadjuvant chemotherapy was well tolerated in patients with locally advanced cervical cancer and showed moderate response activity. Compared to intravenous neoadjuvant chemotherapy, intra-arterial neoadjuvant chemotherapy had an evident advantage in terms of the clinical response while maintaining a similar toxicity rate. The clinical efficacy of intra-arterial neoadjuvant chemotherapy deserves further evaluation.
Highlights
Cervical cancer is the third most common cancer in women worldwide [1]
Candidate studies were pooled for analysis based on the following inclusion criteria: (1) original studies; (2) patients with locally advanced cervical cancer; (3) staging based on the 2009 Federation of Gynecology and Obstetrics (FIGO) system; (4) patients who received no chemotherapy or radiotherapy prior to the clinical trial; (5) cohort or case-control studies that evaluated the safety and/or efficacy of intra-arterial vs. intravenous neoadjuvant chemotherapy; (6) sufficient original data were provided to estimate the treatment effect odds ratios and corresponding 95% confidence intervals; and (7) patients received radical hysterectomy after neoadjuvant chemotherapy without surgical contraindications. e exclusion criteria included the following: (1) review studies or isolated case reports; (2) duplicate studies; (3) missing ethics board approval; (4) studies without full-text articles or incomplete data; and (5) studies not written in English
Four studies lacking information about the particular clinical response, toxicity, or other necessary data were excluded. us, a total of three prospective controlled studies with 112 patients were eventually included in this analysis (Figure 1) [10,11,12]. e Newcastle Ottawa Scale assessment [13] showed that the quality of the two included cohort studies [11, 12] was excellent (6–8 points)
Summary
Cervical cancer is the third most common cancer in women worldwide [1]. With improvements in screening technology, the incidence of cervical cancer has decreased [2]. Some studies have reported that intra-arterial neoadjuvant chemotherapy is associated with a higher clinical response rate than intravenous chemotherapy, resulting in a more favourable prognosis [9,10,11,12]. All of these studies have several limitations, such as small sample sizes, no strict control groups, and retrospective designs. A definitive conclusion cannot be drawn based on the current published
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