2727 Neo-adjuvant chemotherapy followed by surgery vs definitive chemo radiation as treatment for localized carcinoma cervix

Singh, Somesh; Mishra, Ashutosh; Goel, Vineeta; Talwar, Vineet; Raina, Shubhra; Dodagaudar, C.; Mitra, Swarupa; Saxena, U.; Shekhon, R.; Rawal, Sudhir

doi:10.1016/s0959-8049(16)31494-0

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“…Compared with CCRT, the efficacy of NACT+S is still controversial and under investigation. The retrospective study results of Lee et al in 2016 showed that there was no significant difference in survival between stage IB-IIB cervical cancer patients receiving NACT+S and those receiving CCRT [27], and the same results were also suggested in the studies of Singh (stage IB2-IIIA) [28] and Khan (stage IB2 and IIA2) [29]. However, Khan's results indicate that NACT is more advantageous in stage IB2-IIIB patients [30].…”

Section: Discussionmentioning

confidence: 79%

Neoadjuvant chemotherapy plus surgery versus concurrent chemoradiotherapy in stage IB2-IIB cervical cancer: A systematic review and meta-analysis

et al. 2019

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The optimal treatment strategy for stage IB2-IIB cervical cancer is controversial. This systematic review with meta-analysis evaluated the efficacy of concomitant chemoradiotherapy (CCRT) and neoadjuvant chemotherapy followed by radical surgery (NACT+S). Studies that evaluated NACT+S versus CCRT for patients with Federation of Gynecology and Obstetrics stage IB2-IIB cervical cancer were searched in MEDLINE, EMBASE, and the Cochrane Library database. Hazard ratios (HRs) with their respective 95% confidence intervals (CIs) were calculated using a random-effects model. Toxicity was also evaluated. Six qualified retrospective studies and one randomized controlled trial (2270 patients) were included in this review. The results suggested that compared with CCRT, NACT+S did not improve overall survival in all patients (HR 0.73, 95% CI 0.52–1.02) or stage IIB patients (HR 0.83, 95% CI 0.61–1.15). NACT+S did not improve disease-free survival (DFS) in stage IIB patients (HR 1.10, 95% CI 0.70–1.71). In the analysis of DFS in all patients, a high degree of heterogeneity was detected (I2 = 84%). Sensitivity analysis that eliminated these heterogeneous data suggested that CCRT could improve DFS over NACT+S (HR 1.47, 95% CI 1.12–1.93). Diarrhea and rectal and bladder complications occurred at a lower rate in the NACT+S group than in the CCRT group. NACT+S had no survival advantage for patients with stage IB2-IIB cervical cancer compared with CCRT but was associated with fewer side effects. Further prospective studies with a larger sample size of treatment protocols for locally advanced cervical cancer are needed.

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Section: Discussionmentioning

confidence: 79%