Journal
CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY
Volume 184, Issue -, Pages -Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.critrevonc.2023.103953
Keywords
Locally advanced cervical cancer; Concurrent chemo-radiotherapy; Adjuvant chemotherapy; Survival; Meta-analysis
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This study analyzed the treatment of locally advanced cervical cancer (LACC) and found that adjuvant chemotherapy (ACT) does not provide additional survival benefits. However, it is necessary to identify high-risk patients who may benefit from ACT in order to make better treatment decisions.
Background: Locally advanced cervical cancer (LACC) is generally treated using concurrent chemo-radiotherapy (CCRT); yet, the effectiveness of adjuvant chemotherapy (ACT) following CCRT remains controversial. Methods: The databases Embase, Web of Science, and PubMed were analyzed for relevant research. Primary endpoints included overall survival (OS) and progression-free survival (PFS). Results: Fifteen trials with 4041 patients were included. Pooled HRs for PFS and OS were 0.81 (95 % CI: 0.67-0.96) and 0.69 (95 % CI: 0.51-0.93), respectively. However, subgroup analyses indicated that in randomized trials and trials with larger sample sizes (n > 100) as well as ACT cycles <= 3, ACT was not linked with improved PFS and OS. Moreover, ACT induced a greater rate of hematologic toxicities (P < 0.05). Conclusion: Higher quality of evidence suggests that ACT could not yield additional survival benefits for LACC; however, identifying high-risk patients who may benefit from ACT is required to design further clinical trials and better inform treatment decisions.
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