Neoadjuvant chemotherapy plus surgery versus concurrent chemoradiotherapy in stage IB2-IIB cervical cancer: A systematic review and meta-analysis

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.

Clinical Effects of Chinese Herbal Decoction Combined with Basic Chemoradiotherapy and Nursing Intervention in the Treatment of Cervical Cancer and the Effect on Serum CEA, CA125, and TNF-α Levels

“…Chemoradiotherapy for cervical cancer can shrink tumors and enhance parauterine invasion [ 18 ]. Chemotherapy inhibits the reproliferation of tumor cells during the interval of radiotherapy and the repair of sublethal tumor cell damage after radiotherapy, synchronizes the tumor cell cycle, inhibits the repopulation of tumor cells, improves the sensitivity of tumors to radiotherapy, and reduces the recurrence rate, thus improving the prognosis [ 19 – 21 ]. The standard regimen of chemoradiotherapy is often based on cisplatin [ 22 – 25 ].…”

The issue of false positive lymph nodes on [18F] FDG-PET/CT for cervical carcinoma and consequences for treatment

“…Focusing on secondary outcomes as pelvic toxicity, treatment with chemoradiation has a higher risk of bladder and rectal problems [38]. Furthermore, the damage of internal genitals caused by high dose radiation may lead to loss of ovarian function and vaginal fibrosis resulting in postmenopausal and negative sexual symptoms.…”

Neoadjuvant chemotherapy combined with radical surgery for stage IB2/IIA2 cervical squamous cell carcinoma: a prospective, randomized controlled study of 35 patients

“…It can also enable many young patients with early cervical squamous cell carcinoma to retain fertility, but its role in improving prognosis is still controversial [5][6][7]. Several meta-analyses evaluated the prognosis of neoadjuvant chemotherapy combined with surgical treatment and initial surgical treatment, and the results were different [8][9][10].…”