Hysterectomy with radiotherapy or chemotherapy or both for women with locally advanced cervical cancer

Abstract

BackgroundThis is an update of the Cochrane Review published in Issue 4, 2015. Cervical cancer is one of the most frequent cause of death from gynaecological cancers worldwide. Many new cervical cancer cases in low-income countries present at an advanced stage. Standard care in Europe and the US for locally advanced cervical cancer (LACC) is chemoradiotherapy. In low-income countries, with limited access to radiotherapy, LACC may be treated with chemotherapy and hysterectomy. It is not certain if this improves survival. It is important to assess the value of hysterectomy with radiotherapy or chemotherapy, or both, as an alternative. ObjectivesTo determine whether hysterectomy, in addition to standard treatment with radiotherapy or chemotherapy, or both, in women with LACC (Stage IB 2 to III) is safe and e ective compared with standard treatment alone. Search methodsWe searched CENTRAL, MEDLINE via Ovid, Embase via Ovid, LILACS, trial registries and the grey literature up to 3 February 2022. Selection criteriaWe searched for randomised controlled trials (RCTs) that compared treatments involving hysterectomy versus radiotherapy or chemotherapy, or both, in women with LACC International Federation of Gynecology and Obstetrics (FIGO) Stages IB 2 to III. Data collection and analysisWe used standard methodological procedures expected by Cochrane. We independently assessed study eligibility, extracted data and assessed the risk of bias. Where possible, we synthesised overall (OS) and progression-free (PFS) or disease-free (DFS) survival in a metaanalysis using a random-e ects model. Adverse events (AEs) were incompletely reported and we described the results of single trials in narrative form. We used the GRADE approach to assess the certainty of the evidence. Main resultsFrom the searches we identified 968 studies. A er deduplication, title and abstract screening, and full-text assessment, we included 11 RCTs (2683 women) of varying methodological quality. This update identified four new RCTs and three ongoing RCTs.

Exploring a novel seven-gene marker and mitochondrial gene TMEM38A for predicting cervical cancer radiotherapy sensitivity using machine learning algorithms

“…Among these, the combination of surgical procedures and radiotherapy is a commonly utilized clinical approach for treating CC ( 21 ). Radiation therapy can potentially increase survival rates, enhance quality of life, and reduce adverse effects in patients with CC ( 22 ). Nonetheless, numerous clinical studies have uncovered variations in patients’ innate sensitivity to radiation, particularly among those with early or advanced cervical cancer.…”

Prognostic analysis of stage IIIC1p cervical cancer patients

“…Following the 2018 FIGO criteria, all patients with positive pelvic lymph nodes were re-staged to cervical cancer stage IIIC1p and underwent postoperative concurrent chemoradiotherapy (CCRT). The following criteria were used for exclusion ( 1 ): chemotherapy before surgery or radiotherapy ( 2 ), LNM in the para-aortic region ( 3 ), concurrent presence of other tumors ( 4 ), distant metastasis, and ( 5 ) no follow-up data. In this study, we collected data from patients with stage IIIC1p cervical cancer regarding LNM (including common iliac lymph node, number of LNM sites, the number and ratio of LNM), para-aortic lymph nodes (PALN) resection, vaginal brachytherapy utilization, type of radicality, postoperative high-risk factors (surgical margins and parametrial infiltration), intermediate-risk factors (tumor size, lymph-vascular space invasion [LVSI], depth of stromal invasion [DSI]), preoperative tumor markers (squamous cell carcinoma antigen [SCCA] and carcinoembryonic antigen [CEA]), adjuvant treatment regimens (CCRT and CCRT+ adjuvant chemotherapy [AC]), monocyte-to-lymphocyte ratio (MLR), and chemotherapy protocol.…”

“…Radical hysterectomy and lymph node dissection are crucial for patients during the early stages. However, based on existing randomized controlled trials, we found insufficient evidence to suggest that hysterectomy improves the survival of women with locally advanced cervical cancer treated with either radiotherapy or chemoradiotherapy ( 4 ). The chances of pelvic LNM in cervical cancer stages IB2, IIA, and IIB were 11%, 13%, and 16%, respectively ( 5 – 7 ).…”

Neoadjuvant chemotherapy followed by surgery versus concurrent chemoradiotherapy in patients with stage IIB cervical squamous cell carcinoma: a retrospective cohort study

“…Divergent studies have reported variable outcomes. Some studies indicate that surgery may yield overall survival (OS) rates comparable to those achieved with CCRT [ 7 – 10 ]. In contrast, others indicate worse survival outcomes with surgical approaches [ 11 , 12 ].…”