Andrade Matheus de Oliveira, Al-Alam Otavio de Carvalho Modaffar, Kim Henrique Jin Son, Batista João Pedro Thimotheo, Dornellas Débora Maciel Santana, Coelho Ricardo Lima, Borges Vitória Espíndola Leite, Gouveia Mariana Carvalho, Scaranti Mariana, Bonadio Renata Colombo, Gaillard Stephanie, Costa Samantha Cabral Severino
Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Cancer Treat Rev. 2025 Jul;138:102959. doi: 10.1016/j.ctrv.2025.102959. Epub 2025 May 16.
The addition of induction chemotherapy (ICT) prior to concomitant chemoradiotherapy (CCRT) in the treatment of locally advanced cervical cancer (LACC) is controversial, as trials have yielded conflicting results. This study aims to evaluate the role of ICT followed by CCRT in LACC.
We systematically searched PubMed, Embase and Cochrane for studies with patients diagnosed with LACC receiving ICT followed by CCRT. Studies that included surgery, definitive radiotherapy (without concurrent chemotherapy), or immunotherapy were excluded.
Among 5,282 screened studies, 20 met the inclusion criteria, representing 1,543 patients treated with ICT. A meta-analysis of the five controlled studies exhibited high heterogeneity in progression-free survival (PFS) and overall survival (OS), driven by the CIRCE trial - a study employing a platinum-gemcitabine ICT regimen lasting > 6 weeks. Sensitivity analysis excluding this trial demonstrated a significant improvement in PFS (HR 0.46; 95 % CI 0.31-0.69; p = 0.0002) and OS (HR 0.68; 95 % CI 0.47-0.99; p = 0.049) with the addition of ICT to CCRT, compared to CCRT alone. Meta-analysis of proportions revealed a 2-year OS of 84.1 % for studies utilizing platinum-paclitaxel compared to 72.2 % for platinum-gemcitabine (p-value for subgroup difference = 0.022). Studies with ICT duration of ≤ 6 weeks showed a 2-year OS of 84.8 % compared to 71.7 % for ICT duration > 6 weeks (p = 0.003).
In patients with LACC, ICT + CCRT significantly improves PFS and OS compared to CCRT alone, provided that the ICT involves a platinum doublet with paclitaxel and is administered within ≤ 6 weeks.
在局部晚期宫颈癌（LACC）的治疗中，在同步放化疗（CCRT）之前加用诱导化疗（ICT）存在争议，因为相关试验结果相互矛盾。本研究旨在评估ICT序贯CCRT在LACC治疗中的作用。
我们系统检索了PubMed、Embase和Cochrane数据库，查找诊断为LACC且接受ICT序贯CCRT治疗的患者的研究。排除包括手术、单纯根治性放疗（无同步化疗）或免疫治疗的研究。
在5282项筛选的研究中，20项符合纳入标准，代表1543例接受ICT治疗的患者。对五项对照研究的荟萃分析显示，无进展生存期（PFS）和总生存期（OS）存在高度异质性，这主要由CIRCE试验驱动，该试验采用了持续时间超过6周的铂类-吉西他滨ICT方案。排除该试验的敏感性分析表明，与单纯CCRT相比，CCRT加用ICT可显著改善PFS（风险比[HR]0.46；95%置信区间[CI]0.31 - 0.69；p = 0.0002）和OS（HR 0.68；95% CI 0.47 - 0.99；p = 0.049）。比例的荟萃分析显示，使用铂类-紫杉醇的研究2年总生存率为84.1%，而铂类-吉西他滨为72.2%（亚组差异p值 = 0.022）。ICT持续时间≤6周的研究2年总生存率为84.8%，而ICT持续时间>6周的为71.7%（p = 0.003）。
在LACC患者中，与单纯CCRT相比，ICT + CCRT可显著改善PFS和OS，前提是ICT采用含紫杉醇的铂类双联方案且给药时间≤6周。
