Horeweg Nanda, Mittal Prachi, Gradowska Patrycja L, Boere Ingrid, Chopra Supriya, Nout Remi A
Department of Radiation Oncology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands.
Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai 400094, India.
Cancers (Basel). 2021 Apr 14;13(8):1880. doi: 10.3390/cancers13081880.
Standard of care for locally advanced cervical cancer is chemoradiation and brachytherapy. The addition of adjuvant systemic treatment may improve overall survival. A systematic review and meta-analysis was conducted to summarize evidence on survival outcomes, treatment completion and toxicity.
PubMed, EMBASE and Web of Science were systematically searched for relevant prospective and retrospective studies. Two authors independently selected studies, extracted data and assessed study quality. Pooled hazard ratios for survival endpoints were estimated using random effect models. Weighted averages of treatment completion and toxicity rates were calculated and compared by the Fisher exact test.
The search returned 612 articles; 35 articles reporting on 29 different studies on adjuvant chemotherapy or immunotherapy were selected for systematic review. Twelve studies on an adjuvant platinum-pyrimidine antagonist or platinum-taxane were included for meta-analysis. The pooled hazard ratios for overall survival were 0.76 (99%CI: 0.43-1.34, = 0.22) and 0.47 (99%CI: 0.12-1.86, = 0.16) for the addition of, respectively, a platinum-pyrimidine antagonist or platinum-taxane to chemoradiation and brachytherapy. Completion rates were 82% (95%CI: 76-87%) for platinum-pyrimidine antagonist and 74% (95%CI: 63-85%) for platinum-taxane. Severe acute hematological and gastro-intestinal toxicities were significantly increased by adding adjuvant chemotherapy to chemoradiation and brachytherapy.
The addition of adjuvant platinum-pyrimidine antagonist or platinum-taxane after chemoradiation and brachytherapy does not significantly improve overall survival, while acute toxicity is significantly increased. These adjuvant treatment strategies can therefore not be recommended for unselected patients with locally advanced cervical cancer.
局部晚期宫颈癌的标准治疗方案是放化疗及近距离放疗。辅助性全身治疗的加入可能会改善总生存期。开展了一项系统评价和荟萃分析，以总结关于生存结局、治疗完成情况及毒性的证据。
系统检索了PubMed、EMBASE和Web of Science上的相关前瞻性和回顾性研究。两名作者独立筛选研究、提取数据并评估研究质量。使用随机效应模型估计生存终点的合并风险比。计算治疗完成率和毒性率的加权平均值，并通过Fisher精确检验进行比较。
检索共返回612篇文章；选择了35篇报告29项关于辅助化疗或免疫治疗不同研究的文章进行系统评价。纳入了12项关于辅助铂类嘧啶拮抗剂或铂类紫杉烷的研究进行荟萃分析。在放化疗及近距离放疗基础上加用铂类嘧啶拮抗剂或铂类紫杉烷时，总生存期的合并风险比分别为0.76（99%CI：0.43 - 1.34，P = 0.22）和0.47（99%CI：0.12 - 1.86，P = 0.16）。铂类嘧啶拮抗剂的完成率为82%（95%CI：76 - 87%），铂类紫杉烷的完成率为74%（95%CI：63 - 85%）。在放化疗及近距离放疗基础上加用辅助化疗会显著增加严重急性血液学和胃肠道毒性。
在放化疗及近距离放疗后加用辅助铂类嘧啶拮抗剂或铂类紫杉烷并不能显著改善总生存期，同时急性毒性会显著增加。因此，对于未选择的局部晚期宫颈癌患者，不推荐这些辅助治疗策略。
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