Gynecology Tianjin Gong'an Hospital, Tianjin, China.
Eur Rev Med Pharmacol Sci. 2019 Jan;23(2):833-840. doi: 10.26355/eurrev_201901_16898.
The benefits of adjuvant chemoradiotherapy (CRT) in patients with International Federation of Gynecology and Obstetrics (FIGO) stages I-II high-risk endometrial cancer remain controversial. We undertook a systematic review and meta-analysis to assess the efficacy of CRT over radiotherapy (RT) in patients with early-stage high-risk endometrial cancer.
We searched MEDLINE (from 1946 to May 2018), EMBASE (from 1966 to May 2018), and the Cochrane Library database for randomized controlled trials (RCTs) conducted for endometrial cancer comparing CRT to RT alone. The outcomes were overall survival (OS), failure-free survival (FFS), local recurrence rates (LRR) and the distant metastasis rate (DMR).
Three eligible studies with 1120 participants were included in the meta-analysis. All studies were published from 1990 to 2018. The OS rates were 82.5% for the patients in the CRT group and 84.4% for patients in the RT group. The included three RCTs showed no significant difference of OS between the CRT and RT groups (odd ratio 0.98, 95% CI 0.93 to 1.02, p=0.35) with no heterogeneity (I2=0%, p=0.47). Two studies reported 382 FFS events in 469 patients with CRT treatment (81.4%) and 376 events of the 470 patients with RT treatment (80.0%). Overall, CRT group didn't provide any benefit over RT alone (1.02, 0.95 to 1.08, p=0.62; I2 = 0%, p=0.55) in FFS. 39 patients in CRT group (10.2%) vs. 16 patients in RT group (4.3%) were diagnosed with local recurrence. LRR was significantly more common in patients receiving adjuvant chemoradiotherapy compared with adjuvant radiotherapy (2.29, 1.31 to 3.98, p=0.004; I²=0%, p=0.33). The distant metastasis occurred in 20 patients (5.2%) treated with CRT and 26 patients (7.0%) treated with RT. The effect of reducing DMR was equivocal between the CRT group and the RT group, with an OR of 0.74 (0.43-1.27, p=0.28; I²=0%, p=0.87).
This study demonstrates that adjuvant chemoradiotherapy has no advantage over radiotherapy alone for overall survival and failure-free survival in high-risk patients with FIGO stages I-II endometrial cancer. In addition, CRT is associated with a high risk of local recurrences.
国际妇产科联合会（FIGO）分期 I-II 期高危子宫内膜癌患者辅助放化疗（CRT）的获益仍存在争议。我们进行了一项系统评价和荟萃分析，以评估 CRT 相较于单纯放疗（RT）在早期高危子宫内膜癌患者中的疗效。
我们检索了 MEDLINE（从 1946 年至 2018 年 5 月）、EMBASE（从 1966 年至 2018 年 5 月）和 Cochrane 图书馆数据库中，针对比较 CRT 与单纯 RT 治疗子宫内膜癌的随机对照试验（RCT）。结局指标包括总生存（OS）、无失败生存（FFS）、局部复发率（LRR）和远处转移率（DMR）。
3 项纳入的研究共有 1120 名参与者，符合荟萃分析的要求。所有研究均发表于 1990 年至 2018 年。CRT 组患者的 OS 率为 82.5%，RT 组患者的 OS 率为 84.4%。纳入的 3 项 RCT 表明 CRT 与 RT 组之间的 OS 无显著差异（比值比 0.98，95%置信区间 0.93 至 1.02，p=0.35），无异质性（I²=0%，p=0.47）。2 项研究报告了 CRT 治疗组的 382 例 FFS 事件（469 例患者中的 81.4%）和 RT 治疗组的 376 例事件（470 例患者中的 80.0%）。总体而言，CRT 组并未在 FFS 中优于单纯 RT（1.02，0.95 至 1.08，p=0.62；I²=0%，p=0.55）。CRT 组的 39 例（10.2%）患者与 RT 组的 16 例（4.3%）患者发生局部复发。与接受辅助放疗的患者相比，接受辅助放化疗的患者 LRR 显著更为常见（2.29，1.31 至 3.98，p=0.004；I²=0%，p=0.33）。20 例（5.2%）接受 CRT 治疗的患者和 26 例（7.0%）接受 RT 治疗的患者发生远处转移。CRT 组和 RT 组在降低 DMR 方面的效果不确定，其比值比为 0.74（0.43 至 1.27，p=0.28；I²=0%，p=0.87）。
本研究表明，对于 FIGO 分期 I-II 期高危子宫内膜癌患者，辅助放化疗与单纯放疗相比，在总生存和无失败生存方面并无优势。此外，CRT 与较高的局部复发风险相关。
