A Cochrane review [Abstract] 1 included 6 studies with a total of 1078 subjects. Both progression-free survival (HR 0.75, 95% CI 0.61 to 0.93, P = 0.008; 6 trials, n=986), and overall survival (HR 0.77, 95% CI 0.62 to 0.96, P = 0.02; 6 trials, n=1071) were significantly improved with neoadjuvant chemotherapy. The estimate for local recurrence was in favour of neoadjuvant chemotherapy, although heterogeneity was observed, and the result was no longer significant when the random-effects model was used. Whilst not significant, estimates for distant recurrence and rates of resection tended to favour neoadjuvant chemotherapy, although heterogeneity was observed. Post-hoc analyses of pathological response showed a significant decrease in adverse pathological findings with neoadjuvant chemotherapy (OR 0.54, 95% CI 0.39 to 0.73 for lymph node status; OR 0.58, 95% CI 0.41 to 0.82 for parametrial infiltration; n=903). There was also no difference in the effect of neoadjuvant chemotherapy according to total cisplatin dose, chemotherapy cycle length or by cervical cancer stage.
A meta-analysis 3 evaluated the efficacy of neoadjuvant chemotherapy (NACT) with radical surgery vs radical surgery alone for cervical cancer. 13 studies involving 2 158 subjects were included. In regard to overall survival (OS), disease free survival, and progression free survival, local and distant recurrence, and parametrial infiltration, neoadjuvant chemotherapy plus radical surgery was similar to radical surgery alone. Among them, subgroup analysis of 8 studies with 1544 patients with locally advanced cervical cancer (FIGO stage IB2-IIB) showed that neoadjuvant chemotherapy (NACT) plus radical surgery significantly improved OS, and decreased local and distant recurrence rates, lymph node metastasis rate, and the level of parametrial infiltration compared to radical surgery alone.
Another meta-analysis 2 evaluated the efficacy and safety of neo-adjuvant chemotherapy (NACT) plus radical surgery (RS) versus radical surgery for patients with cervical cancer. Five RCT involving 739 patients were included. There were significant differences between the NACT + RS and the RS-alone groups for positive lymph nodes (OR 0.45; 95%CI 0.29 to 0.70) and parametrial infiltration (OR 0.48; 95% CI 0.25 to 0.92), while treatment efficacy did not differ significantly for 5-year overall survival rate (OR 1.17; 95% CI 0.85 to 1.61), 5-year disease-free survival rate (OR 1.09; 95% CI 0.77 to 1.56) or recurrence rate (OR 1.17; 95% CI 0.85 to 1.61). The results also indicated that chemotherapy-related toxicity was well tolerated.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).
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