Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Significant Efficacy of Additional Concurrent Chemotherapy with Radiotherapy for Postoperative Cervical Cancer with Risk Factors: a Systematic Review and Meta-analysis

  • Qin, Ai-Qiu (Department of Gynecology Oncology, the Affiliated Tumor Hospital of Guangxi Medical University) ;
  • Liang, Zhong-Guo (Department of Radiation Oncology, the Affiliated Tumor Hospital of Guangxi Medical University) ;
  • Ye, Jia-Xiang (Department of Medical Oncology, the Affiliated Tumor Hospital of Guangxi Medical University) ;
  • Li, Jing (Department of Gynecology Oncology, the Affiliated Tumor Hospital of Guangxi Medical University) ;
  • Wang, Jian-Li (Department of Gynecology Oncology, the Affiliated Tumor Hospital of Guangxi Medical University) ;
  • Chen, Chang-Xian (Department of Gynecology Oncology, the Affiliated Tumor Hospital of Guangxi Medical University) ;
  • Song, Hong-Lin (Department of Gynecology Oncology, the Affiliated Tumor Hospital of Guangxi Medical University)
  • Published : 2016.08.01
⟨ Previous Next ⟩

Abstract

Background: Whether concurrent chemotherapy treatment is superior to radiotherapy alone as an adjuvant regimen for postoperative cervical carcinoma with risk factors remains controversial. Materials and Methods: A literature search strategy examined Pubmed, Embase, the Cochrane Library, the China National Knowledge Internet Web, the Chinese Biomedical Database and the Wanfang Database. Article reference lists and scientific meeting abstracts were also screened. Controlled trials comparing concurrent chemoradiotherapy versus radiotherapy alone in postoperative cervical cancer were included. The methodological quality of non-randomized controlled trials was evaluated using the Newcastle-Ottawa Scale. Randomized controlled studies were evaluated with the Cochrane handbook. A meta-analysis was performed with RevMan 5.3. Results: A total of 1,073 patients from 11 clinical trials were analysed, with 582 patients in the concurrent chemoradiotherapy group and 491 patients in the radiotherapy group. Hazard ratios (HR) of 0.47 (95% CI 0.31-0.72) and 0.50 (95% CI 0.35-0.72) were observed for overall survival and progression-free survival, indicating a benefit from the additional use of concurrent chemotherapy. Subgroup analyses demonstrated that cervical cancer with high risk factors significantly benefitted from concurrent chemotherapy when examining overall survival (HR 0.44, 95% CI 0.28-0.67) and progression-free survival (HR 0.48, 95% CI 0.33-0.70), but patients with intermediate risk factors showed no benefit from concurrent chemotherapy in overall survival (HR 1.72, 95% CI 0.28-10.41) and progression-free survival (HR 1.09, 95% CI 0.19-6.14). No significant differences were observed for grade 3-4 anaemia (risk ratio (RR) 3.87, 95% CI 0.69-21.84), grade 3-4 thrombocytopenia (RR 3.04, 95% CI 0.88-10.58), grade 3-4 vomiting or nausea (RR 1.71, 95% CI 0.27-10.96), or grade 3-4 diarrhoea (RR 1.40, 95% CI 0.69-2.83). Significant differences were observed for grade 3-4 neutropenia in favour of the radiotherapy group (RR 7.23, 95% CI 3.94-13.26). Conclusions: In conclusion, concurrent chemoradiotherapy improves survival in postoperative cervical cancer with high risk factors but not in those with intermediate risk factors.

Keywords

References

  1. Ariga T, Toita T, Kato S, et al (2015). Treatment outcomes of patients with FIGO Stage I/II uterine cervical cancer treated with definitive radiotherapy: a multi-institutional retrospective research study. J Radiat Res, 56, 841-8. https://doi.org/10.1093/jrr/rrv036
  2. Bidus MA, Elcas JC (2007). Cervical and vaginal cancer. In: Berek & Novak's gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins, 1403-1456,
  3. Choi CH, Lee YY, Kim MK, et al (2011). A matchedcase comparison to explore the role of consolidation chemotherapy after concurrent chemoradiation in cervical cancer. Int J Radiat Oncol Biol Phys, 81, 1252-7. https://doi.org/10.1016/j.ijrobp.2010.07.2006
  4. Dai JL, Li J, Zhang HF, et al (2014). Observation of the curative efficacy and adverse reaction in vascular cancer embolus positive patients with postoperative chemoradiotherapy of the cervical cancer. Clin Med, 36, 346-50.
  5. Derks M, Biewenga P, van der Velden J, et al (2016). Results of radical surgery in women with stage IB2/IIA2 cervical cancer. Acta Obstet Gynecol Scand, 95, 166-72. https://doi.org/10.1111/aogs.12819
  6. Duenas-Gonzalez A, Zarba JJ, Patel F, et al (2011). Phase III, open-label, randomized study comparing concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin versus concurrent cisplatin and radiation in patients with stage IIB to IVA carcinoma of the cervix. J Clin Oncol, 29, 1678-85. https://doi.org/10.1200/JCO.2009.25.9663
  7. Huang D-N, Li G-S, Huang H-X, et al (2007). The effect of concurrent chemoradiotherapy on postoperative early stage cervical cancer with high-risk facors. Youjiang Med J, 35, 20-1.
  8. Julian PTH, Sally G. (2011). Cochrane handbook for systematic review of interventions version 5.0.1. The cochrane collaboration. Available: http:www.cochranehandbook.org.
  9. Kim HJ, Rhee WJ, Choi SH, et al (2015). Clinical outcomes of adjuvant radiation therapy and prognostic factors in early stage uterine cervical cancer. Radiat Oncol J, 33, 126-33. https://doi.org/10.3857/roj.2015.33.2.126
  10. Kim K, Kang SB, Chung HH, et al (2009). Comparison of chemoradiation with radiation as postoperative adjuvant therapy in cervical cancer patients with intermediate-risk factors. Eur J Surg Oncol, 35, 192-6. https://doi.org/10.1016/j.ejso.2008.04.004
  11. Kobayashi Y, Ohara T, Wada Y, et al (2009). Concurrent chemoradiotherapy with nedaplatin after radical hysterectomy in patients with stage IB and II cervical cancer. J Obstet Gynaecol Res, 35, 490-4. https://doi.org/10.1111/j.1447-0756.2008.00955.x
  12. Kunos C, Ali S, Abdul-Karim FW, et al (2010). Posttherapy residual disease associates with long-term survival after chemoradiation for bulky stage 1B cervical carcinoma: A Gynecologic Oncology Group study. Am J Obstet Gynecol, 203, 351 1-.8.
  13. Lin G-S, Cheng H-H, Li D-S (2009). Compare the effect of concurrent chemoradiotherapy with sequential treatment on early stage postoperative cervical carcinoma with high-risk factors. Chin Clin Oncol, 14, 541-3.
  14. Mabuchi S, Morishige K, Isohashi F, et al (2009). Postoperative concurrent nedaplatin-based chemoradiotherapy improves survival in early-stage cervical cancer patients with adverse risk factors. Gynecol Oncol, 115, 482-7. https://doi.org/10.1016/j.ygyno.2009.09.002
  15. Mabuchi S, Okazawa M, Isohashi F, et al (2011). Postoperative whole pelvic radiotherapy plus concurrent chemotherapy versus extended-field irradiation for early-stage cervical cancer patients with multiple pelvic lymph node metastases. Gynecol Oncol, 120, 94-100. https://doi.org/10.1016/j.ygyno.2010.09.016
  16. Matsuo K, Mabuchi S, Okazawa M, et al (2015). Clinical implication of surgically treated early-stage cervical cancer with multiple high-risk factors. J Gynecol Oncol, 26, 3-11. https://doi.org/10.3802/jgo.2015.26.1.3
  17. Monk BJ, Wang J, Im S, et al (2005). Rethinking the use of radiation and chemotherapy after radical hysterectomy: A clinical-pathologic analysis of a gynecologic oncology group/southwest oncology group/radiation therapy oncology group trial. Gynecol Oncol, 96, 721-8. https://doi.org/10.1016/j.ygyno.2004.11.007
  18. Okazawa M, Mabuchi S, Isohashi F, et al (2013). Impact of the addition of concurrent chemotherapy to pelvic radiotherapy in surgically treated stage IB1-IIB cervical cancer patients with intermediate-risk or high-risk factors: a 13-year experience. Int J Gynecol Cancer, 23, 567-75. https://doi.org/10.1097/IGC.0b013e31828703fd
  19. Park TK, Kim SN, Kwon JY, et al (2001). Postoperative adjuvant therapy in early invasive cervical cancer patients with histopathologic high-risk factors. Int J Gynecol Cancer, 11, 475-82. https://doi.org/10.1046/j.1525-1438.2001.01057.x
  20. Peters WA, Liu PY, Barrett RJ, et al (2000). Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol, 18, 1606-13. https://doi.org/10.1200/JCO.2000.18.8.1606
  21. Ryu SY, Park SI, Nam BH, et al (2011). Is adjuvant chemoradiotherapy overtreatment in cervical cancer patients with intermediate risk factors? Int J Radiat Oncol Biol Phys, 79, 794-9. https://doi.org/10.1016/j.ijrobp.2009.11.019
  22. Sadalla JC, Andrade JM, Genta ML, et al (2015). Cervical cancer: what's new? Rev Assoc Med Bras, 61, 536-42. https://doi.org/10.1590/1806-9282.61.06.536
  23. Shibata K, Kajiyama H, Terauchi M, et al (2008). Feasibility and effectiveness of postoperative adjuvant concurrent chemoradiation therapy in Japanese patients with high-risk early-stage cancer of the uterine cervix. Int J Clin Oncol, 13, 233-8. https://doi.org/10.1007/s10147-007-0744-0
  24. Stehman FB, Ali S, Keys HM, et al (2007). Radiation therapy with or without weekly cisplatin for bulky stage 1B cervical carcinoma: follow-up of a Gynecologic Oncology Group trial. Am J Obstet Gynecol, 197, 503 e1-6.
  25. Sun W, Wang T, Shi F, et al (2015). Randomized phase III trial of radiotherapy or chemoradiotherapy with topotecan and cisplatin in intermediate-risk cervical cancer patients after radical hysterectomy. BMC Cancer, 15, 353. https://doi.org/10.1186/s12885-015-1355-1
  26. Tierney JF, Stewart LA, Ghersi D, et al (2007). Practical methods for incorporating summary time-to-event data into metaanalysis. Trials, 8, 16. https://doi.org/10.1186/1745-6215-8-16
  27. Torre LA, Bray F, Siegel RL, et al (2015). Global cancer statistics, 2012. CA Cancer J Clin, 65, 87-108. https://doi.org/10.3322/caac.21262
  28. Wang JQ, Wang T, Shi F, et al (2015). A randomized controlled trial comparing clinical outcomes and toxicity of lobaplatinversus cisplatin-based concurrent chemotherapy plus radiotherapy and high-dose-rate brachytherapy for FIGO stage II and III cervical cancer. Asian Pac J Cancer Prev, 16, 5957-61. https://doi.org/10.7314/APJCP.2015.16.14.5957
  29. Wells GA, Shea B, O'Connell D, et al (2011). The Newcastle- Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses, Ottawa:Ottawa Hospital Research Institute.