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Neoadjuvant chemotherapy plus surgery versus concurrent chemoradiotherapy in stage IB2-IIB cervical cancer: A systematic review and meta-analysis
- Source :
- PLoS ONE, Vol 14, Iss 11, p e0225264 (2019), PLoS ONE
- Publication Year :
- 2019
- Publisher :
- Public Library of Science (PLoS), 2019.
-
Abstract
- The optimal treatment strategy for stage IB2-IIB cervical cancer is controversial. This systematic review with meta-analysis evaluated the efficacy of concomitant chemoradiotherapy (CCRT) and neoadjuvant chemotherapy followed by radical surgery (NACT+S). Studies that evaluated NACT+S versus CCRT for patients with Federation of Gynecology and Obstetrics stage IB2-IIB cervical cancer were searched in MEDLINE, EMBASE, and the Cochrane Library database. Hazard ratios (HRs) with their respective 95% confidence intervals (CIs) were calculated using a random-effects model. Toxicity was also evaluated. Six qualified retrospective studies and one randomized controlled trial (2270 patients) were included in this review. The results suggested that compared with CCRT, NACT+S did not improve overall survival in all patients (HR 0.73, 95% CI 0.52–1.02) or stage IIB patients (HR 0.83, 95% CI 0.61–1.15). NACT+S did not improve disease-free survival (DFS) in stage IIB patients (HR 1.10, 95% CI 0.70–1.71). In the analysis of DFS in all patients, a high degree of heterogeneity was detected (I2 = 84%). Sensitivity analysis that eliminated these heterogeneous data suggested that CCRT could improve DFS over NACT+S (HR 1.47, 95% CI 1.12–1.93). Diarrhea and rectal and bladder complications occurred at a lower rate in the NACT+S group than in the CCRT group. NACT+S had no survival advantage for patients with stage IB2-IIB cervical cancer compared with CCRT but was associated with fewer side effects. Further prospective studies with a larger sample size of treatment protocols for locally advanced cervical cancer are needed.
- Subjects :
- Oncology
medicine.medical_treatment
Cancer Treatment
Uterine Cervical Neoplasms
Cervical Cancer
Toxicology
Pathology and Laboratory Medicine
Mathematical and Statistical Techniques
0302 clinical medicine
Medicine and Health Sciences
Stage (cooking)
Prospective cohort study
Neoadjuvant therapy
Aged, 80 and over
Cervical cancer
030219 obstetrics & reproductive medicine
Multidisciplinary
Pharmaceutics
Statistics
Hazard ratio
Chemoradiotherapy
Middle Aged
Metaanalysis
Neoadjuvant Therapy
Surgical Oncology
Chemotherapy, Adjuvant
030220 oncology & carcinogenesis
Physical Sciences
Medicine
Female
Research Article
Adult
Clinical Oncology
medicine.medical_specialty
Science
Radiation Therapy
Surgical and Invasive Medical Procedures
Research and Analysis Methods
Cancer Chemotherapy
03 medical and health sciences
Drug Therapy
Internal medicine
medicine
Humans
Chemotherapy
Statistical Methods
Radical surgery
Aged
Neoplasm Staging
Proportional Hazards Models
Toxicity
business.industry
Cancers and Neoplasms
Biology and Life Sciences
medicine.disease
Radiation therapy
Clinical Medicine
business
Gynecological Tumors
Mathematics
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 14
- Database :
- OpenAIRE
- Journal :
- PLOS ONE
- Accession number :
- edsair.doi.dedup.....f6aba0827174f11584af2b62d38a68cf