Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix

Abstract

BackgroundThe National Cancer Institute (USA) alert in February 1999 stated that concomitant chemoradiotherapy should be considered for all patients with cervical cancer, based on evidence from five randomised controlled trials (RCTs). ObjectivesTo review all known RCTs comparing concomitant chemotherapy and radiation therapy with radiotherapy for locally advanced cervical cancer. Search strategyWe searched electronic databases, trials registers and reference lists of published trial reports and review articles were also searched. Selection criteriaThis review includes RCTs in cervical cancer comparing concomitant chemoradiation with radiotherapy in the experimental arm. Trials allowing further adjuvant chemotherapy or hydroxyurea were incuded. Trials using radiosensitisers or radioprotectors in the experimental arm were excluded. Data collection and analysisTwo authors reviewed trials for inclusion and extracted data. For meta-analyses of time-to-event outcomes (survival, progression-free survival), a hazard ratio (HR) was extracted or estimated from trial reports, where possible. Only overall rates of local and distant recurrence were presented in many reports so only odds ratios (OR) of recurrence rates could be calculated, which takes no account of time to recurrence or censoring. Few trials reported acute toxicity adequately, but where possible ORs were calculated for the main types and severities of acute toxicity. The HRs and ORs for individual trials were combined across all trials, using the fixed effect model. Late toxicity was rarely described in sifficient detail so could only be reviewed qualitatively.

Supervivencia de pacientes con cáncer de cuello uterino tratadas en el Instituto Nacional de Cancerología

“…La literatura reciente ha demostrado que el uso de radioterapia concomitante con la quimioterapia en los estadios I y II, mejora la supervivencia global y libre de enfermedad (17). Sin embargo, este estudio muestra una baja práctica del uso combinado de quimioterapia y radioterapia en pacientes en estos estadios; esto puede obedecer a que estos datos se generaron de manera muy cercana al periodo en el cual se incluyeron las pacientes para este estudio.…”

Concomitant and Neoadjuvant Chemotherapy for Cervical Cancer

“…Many of the women in the trials had early-stage disease and a number of trials actively excluded women with involved paraortic nodes, such that the impact of chemoradiotherapy on more advanced or poorer prognosis disease was less clear. A major finding was that chemoradiotherapy appeared to have a systematic as well a local effect, but a significant reduction in metastases was not seen when this review was updated to include more trials and further follow-up [18]. Also, any potential adverse effects of chemoradiotherapy in the long term could not be assessed.…”

“The effect of treatment prolongation in treatment of cervical cancer patient” –treated patients at rural center in India”

“…Results of the trial by NCI of Canada clinical trial group did not reveal any benefit with concurrent chemoradiotherapy [6]. Metanalysis [7] revealed significantly better survival using concurrent chemoradiotherapy as compared to radiotherapy alone (Green et al, 2006). In their subgroup analysis survival advantage was more pronounced among early stage disease.…”