Department of Radiation Oncology, Shantou Central Hospital, Shantou, China.
Department of Intensive Care Medicine, Cancer Hospital of Shantou University Medical College, Shantou, China.
Gynecol Oncol. 2018 Sep;150(3):412-419. doi: 10.1016/j.ygyno.2018.07.005. Epub 2018 Jul 8.
We aimed to evaluate whether carboplatin has a comparable efficacy with cisplatin as part of weekly concurrent chemoradiotherapy for cervical cancer (Car-RT vs. Cis-RT).
A literature search was conducted and both prospective and retrospective studies that evaluated the efficacy of Car-RT for cervical cancer were included. The primary endpoints were complete response (CR) rate, progression-free survival (PFS)/disease-free survival (DFS), overall survival (OS), reported as odds ratios (ORs) and 95% confidence intervals (CIs). The estimated CR rate and survival of patients treated with Car-RT were pooled. Acute toxicity was also summarized.
Twelve studies consisting of 1698 patients were eligible for meta-analysis. A lower CR rate (OR, 0.53; 95% CI, 0.34-0.82, I = 0%) and a trend toward poorer 3-year PFS/DFS (OR, 0.71; 95% CI, 0.49-1.02, I = 0%) and 3-year OS (OR, 0.70; 95% CI, 0.46-1.05, I = 36%) were found in Car-RT compared with Cis-RT. For the Car-RT groups, the pooled overall CR rate was 81% (95% CI 0.74-0.89). The pooled 3-year PFS/DFS rate was 64% (95% CI 0.52-0.78). The pooled 3-year OS rate was 73% (95% CI 0.62-0.87). Acute toxic events ≥ grade 3 were infrequent in the Car-RT groups.
Car-RT showed a poorer tumor response and a trend toward inferior survival compared with Cis-RT in the treatment of cervical cancer. However, this evidence was limited by the imbalance among studies. Due to the encouraging efficacy and low toxicity, carboplatin is a suitable concurrent agent for patients with contraindications to cisplatin.
我们旨在评估卡铂作为宫颈癌每周同期放化疗的一部分（卡铂同期放化疗（Car-RT）与顺铂同期放化疗（Cis-RT））是否具有与顺铂相当的疗效。
进行了文献检索，纳入了评估 Car-RT 治疗宫颈癌疗效的前瞻性和回顾性研究。主要终点为完全缓解（CR）率、无进展生存（PFS）/无病生存（DFS）、总生存（OS），报告为比值比（OR）和 95%置信区间（CI）。汇总了接受 Car-RT 治疗的患者的估计 CR 率和生存情况。还总结了急性毒性。
共有 12 项研究（共 1698 例患者）符合纳入标准。Car-RT 组的 CR 率较低（OR，0.53；95%CI，0.34-0.82，I = 0%），3 年 PFS/DFS（OR，0.71；95%CI，0.49-1.02，I = 0%）和 3 年 OS（OR，0.70；95%CI，0.46-1.05，I = 36%）的趋势较差。Car-RT 组的总体完全缓解率为 81%（95%CI 0.74-0.89）。3 年 PFS/DFS 率为 64%（95%CI 0.52-0.78）。3 年 OS 率为 73%（95%CI 0.62-0.87）。Car-RT 组急性毒性事件≥3 级者不常见。
与 Cis-RT 相比，Car-RT 治疗宫颈癌的肿瘤反应较差，生存趋势较差。然而，由于研究之间存在不平衡，这一证据受到限制。由于疗效令人鼓舞且毒性较低，卡铂是顺铂禁忌证患者的合适同期药物。
