Platinum single-agent vs. platinum-based doublet agent concurrent chemoradiotherapy for locally advanced cervical cancer: A meta-analysis of randomized controlled trials.

OBJECTIVES

This study compared treatment outcomes and adverse events in patients with locally advanced cervical cancer undergoing radiotherapy (RT) with concurrent platinum-based doublet therapy vs. RT plus platinum single-agent therapy. The main outcomes were progression-free survival (PFS), overall survival (OS), and the occurrence of adverse events.

METHODS

We comprehensively searched Medline, Embase, the Cochrane Library, China National Knowledge Web, Wanfang Database, and VIP database, and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) by using the fixed-effect or random-effect models. The primary endpoints were OS and PFS, reported as hazard ratios (HRs) and 95% confidence intervals (95% CIs). The meta-analysis was performed with RevMan 5.2.

RESULTS

Seven randomized trials including 1503 patients were identified. The meta-analysis showed that, for locally advanced cervical cancer, concurrent RT with platinum-based doublet chemotherapy significantly improved the OS (HR 0.75, 95% CI 0.60-0.94, p = 0.01) and the PFS (HR 0.78, 95% CI 0.65-0.94，p = 0.01) compared to RT with cisplatin monotherapy. Grade 3 or 4 vomiting (related ratio [RR] = 3.19, 95% CI 1.85-5.49, p < 0.0001) and thrombocytopenia (RR = 2.75, 95% CI 1.39-5.44, p = 0.004) occurred more frequently in the polychemotherapy arm. The incidence of urinary system toxicity tended to be higher in the polychemotherapy arm (RR = 4.58, 95% CI 1.00-20.89, p = 0.05).

CONCLUSIONS

Under the premise of good tolerance, RT plus platinum-based doublet therapy improves survival compared to RT plus platinum single-agent therapy in patients with locally advanced cervical cancer.