Adjuvant systemic therapy after chemoradiation and brachytherapy for locally advanced cervical cancer: A systematic review and meta-analysis

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Abstract

Background: 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. Methods: PubMed, EMBASE and Web of Science were system-atically searched for relevant prospective and retrospective studies. Two authors independently selected studies, extracted data and assessed study quality. Pooled hazard ratios for survival end-points were estimated using random effect models. Weighted averages of treatment completion and toxicity rates were calculated and compared by the Fisher exact test. Results: The search returned 612 articles; 35 articles reporting on 29 different studies on adjuvant chemotherapy or immunother-apy 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, p = 0.22) and 0.47 (99%CI: 0.12–1.86, p = 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. Conclusions: The addition of adjuvant platinum–pyrimidine antagonist or plati-num–taxane after chemoradiation and brachytherapy does not significantly improve overall sur-vival, while acute toxicity is significantly increased. These adjuvant treatment strategies can there-fore not be recommended for unselected patients with locally advanced cervical cancer.

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Horeweg, N., Mittal, P., Gradowska, P. L., Boere, I., Chopra, S., & Nout, R. A. (2021, April 2). Adjuvant systemic therapy after chemoradiation and brachytherapy for locally advanced cervical cancer: A systematic review and meta-analysis. Cancers. MDPI AG. https://doi.org/10.3390/cancers13081880

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