Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix

Abstract

BackgroundThe National Cancer Institute (USA) alert in February 1999 stated that concomitant chemoradiotherapy should be considered for all patients with cervical cancer, based on evidence from five randomised controlled trials (RCTs). ObjectivesTo review all known RCTs comparing concomitant chemotherapy and radiation therapy with radiotherapy for locally advanced cervical cancer. Search strategyWe searched electronic databases, trials registers and reference lists of published trial reports and review articles were also searched. Selection criteriaThis review includes RCTs in cervical cancer comparing concomitant chemoradiation with radiotherapy in the experimental arm. Trials allowing further adjuvant chemotherapy or hydroxyurea were incuded. Trials using radiosensitisers or radioprotectors in the experimental arm were excluded. Data collection and analysisTwo authors reviewed trials for inclusion and extracted data. For meta-analyses of time-to-event outcomes (survival, progression-free survival), a hazard ratio (HR) was extracted or estimated from trial reports, where possible. Only overall rates of local and distant recurrence were presented in many reports so only odds ratios (OR) of recurrence rates could be calculated, which takes no account of time to recurrence or censoring. Few trials reported acute toxicity adequately, but where possible ORs were calculated for the main types and severities of acute toxicity. The HRs and ORs for individual trials were combined across all trials, using the fixed effect model. Late toxicity was rarely described in sifficient detail so could only be reviewed qualitatively.

An Audit of the Clinical Profile and Outcomes of Cervical Cancer: A Retrospective Analysis.

“…In this study, all patients underwent radiation therapy, with the majority of them receiving chemoradiotherapy. It was observed that the overall survival rates were higher among patients who received chemoradiotherapy, consistent with previous studies [8,9]. Additionally, brachytherapy was administered to most patients, contributing significantly to the overall survival rate.…”

An Audit of the Clinical Profile and Outcomes of Cervical Cancer: A Retrospective Analysis.

“…In this study, all patients underwent radiation therapy, with the majority of them receiving chemoradiotherapy. It was observed that the overall survival rates were higher among patients who received chemoradiotherapy, consistent with previous studies [8,9]. Additionally, brachytherapy was administered to most patients, contributing significantly to the overall survival rate.…”

Adjuvant platinum-based chemotherapy for early stage cervical cancer

“…Similar results were found in a systematic review of concurrent chemoradiation for locally advanced cancer of the uterine cervix (stage IB to IVA), giving an absolute benefit of 10% in OS and of 13% in PFS (Green 2005). In the meta-analysis of Green 2005, acute toxicity, predominantly haematological and gastro-intestinal, was increased in the combined arms (concomitant chemoradiation) of all trials evaluating locally advanced cervical cancer. The CCCMAC 2010 review of Individual Patient Data found an absolute OS benefit of chemoradiation versus radiotherapy of 6% (P < 0.001) in locally advanced cervical cancer.…”

Novel predictive biomarkers for cervical cancer prognosis

“…A number of patients do not respond adequately in the management of invasive cervical cancer, and this number increases when treated with exclusive radiotherapy compared with radiochemotherapy, a situation observed in the present study. A potential survival benefit of 12% is attributable to the use of chemoradiotherapy (28). This confirms the recommendation made by the American Society of Clinical Oncology, which advises to privilege concomitant radiochemotherapy for patients with locally advanced cervical cancer.…”

An Audit of the Clinical Profile and Outcomes of Cervical Cancer: A Retrospective Analysis.

“…In this study, all patients underwent radiation therapy, with the majority of them receiving chemoradiotherapy. It was observed that the overall survival rates were higher among patients who received chemoradiotherapy, consistent with previous studies [8,9]. Additionally, brachytherapy was administered to most patients, contributing significantly to the overall survival rate.…”

Adjuvant platinum-based chemotherapy for early stage cervical cancer

“…Similar results were found in a systematic review of concurrent chemoradiation for locally advanced cancer of the uterine cervix (stage IB to IVA), giving an absolute benefit of 10% in OS and of 13% in PFS (Green 2005). In the meta-analysis of Green 2005, acute toxicity, predominantly haematological and gastro-intestinal, was increased in the combined arms (concomitant chemoradiation) of all trials evaluating locally advanced cervical cancer. The CCCMAC 2010 review of Individual Patient Data found an absolute OS benefit of chemoradiation versus radiotherapy of 6% (P < 0.001) in locally advanced cervical cancer.…”

Novel predictive biomarkers for cervical cancer prognosis

“…A number of patients do not respond adequately in the management of invasive cervical cancer, and this number increases when treated with exclusive radiotherapy compared with radiochemotherapy, a situation observed in the present study. A potential survival benefit of 12% is attributable to the use of chemoradiotherapy (28). This confirms the recommendation made by the American Society of Clinical Oncology, which advises to privilege concomitant radiochemotherapy for patients with locally advanced cervical cancer.…”

An Audit of the Clinical Profile and Outcomes of Cervical Cancer: A Retrospective Analysis.

“…In this study, all patients underwent radiation therapy, with the majority of them receiving chemoradiotherapy. It was observed that the overall survival rates were higher among patients who received chemoradiotherapy, consistent with previous studies [8,9]. Additionally, brachytherapy was administered to most patients, contributing significantly to the overall survival rate.…”

Adjuvant platinum-based chemotherapy for early stage cervical cancer

“…Similar results were found in a systematic review of concurrent chemoradiation for locally advanced cancer of the uterine cervix (stage IB to IVA), giving an absolute benefit of 10% in OS and of 13% in PFS (Green 2005). In the meta-analysis of Green 2005, acute toxicity, predominantly haematological and gastro-intestinal, was increased in the combined arms (concomitant chemoradiation) of all trials evaluating locally advanced cervical cancer. The CCCMAC 2010 review of Individual Patient Data found an absolute OS benefit of chemoradiation versus radiotherapy of 6% (P < 0.001) in locally advanced cervical cancer.…”

Novel predictive biomarkers for cervical cancer prognosis

“…A number of patients do not respond adequately in the management of invasive cervical cancer, and this number increases when treated with exclusive radiotherapy compared with radiochemotherapy, a situation observed in the present study. A potential survival benefit of 12% is attributable to the use of chemoradiotherapy (28). This confirms the recommendation made by the American Society of Clinical Oncology, which advises to privilege concomitant radiochemotherapy for patients with locally advanced cervical cancer.…”