scholarly journals Neoadjuvant Chemotherapy Followed by Radical Surgery versus Radiotherapy (with or without Chemotherapy) in Patients with Stage IB2, IIA, or IIB Cervical Cancer: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Qingjian Ye ◽  
Yuebo Yang ◽  
Xinran Tang ◽  
Jing Li ◽  
Xiaomao Li ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Adverse Events ◽  
Radical Surgery ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Cochrane Library ◽  
Therapeutic Effects ◽  
Long Term Effects ◽  
Case Control Studies

Background. This study was to compare the efficacy and safety between neoadjuvant chemotherapy followed by radical surgery (NACT+RS) and radiotherapy only (RT) or concurrent chemoradiotherapy (CCRT) for treatment of patients with stage IB2, IIA, or IIB cervical cancer. Method. The electronic databases of PubMed, Embase, and the Cochrane Library were searched to screen relevant studies from their inception to October 2018. Clinical data including overall survival (OS), disease-free survival (DFS), and adverse events were extracted. Egger’s test was used to evaluate the publication bias, and sensitivity analysis was conducted to estimate the robustness of results. Results. Finally, three randomized controlled trials (RCTs) and two case-control studies consisting of 1,275 patients with stage IB2, IIA, or IIB cervical cancer were included in the current study. Overall, pooled results showed no significant differences in OS ((hazard ratio HR=0.603, 95%CI=0.350−1.038) and DFS (HR=0.678, 95%CI=0.242−1.904) for patients treated with NACT+RS compared with RT only or CCRT, but the subgroup analysis showed that the OS and DFS were significantly longer in the NACT+RS groups than the RT or CCRT group (OS: HR=0.431, 95%CI=0.238−0.781, p=0.006; DFS: HR=0.300, 95%CI=0.187−0.482, p<0.001) for the population with median follow-up time of more than 60 months. For adverse events, the incidence of thrombocytopenia in the NACT+RS group was significantly higher than that in the RT only or CCRT group (relative risk RR=3.240, 95% CI 1.575-6.662), while the incidence of diarrhea was significantly lower than that in the RT only or CCRT group (RR=0.452, 95% CI =0.230-0.890). Conclusion. These findings suggest that the short-term therapeutic effects of the two treatments may be possibly equal for patients with stage IB2-IIB cervical cancer, but the long-term effects for improving OS and DFS may be better using NACT+RS compared with the RT only or CCRT.

Neoadjuvant chemotherapy followed by radical surgery versus concurrent chemoradiotherapy in patients with FIGO stage IIB cervical cancer: the CSEM 006 study

2020 ◽  
Vol 31 (1) ◽  
pp. 129-133
Author(s):  
Hua Tu ◽  
He Huang ◽  
Yi Ouyang ◽  
Qing Liu ◽  
Bingna Xian ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Sample Size ◽  
Primary Endpoint ◽  
Concurrent Chemoradiotherapy ◽  
Radical Surgery ◽  
Disease Free Survival ◽  
Squamous Carcinoma ◽  
Figo Stage ◽  
Paraaortic Lymphadenectomy

BackgroundConcurrent chemoradiotherapy is the first-line treatment for FIGO stage IIB cervical cancer. Neoadjuvant chemotherapy followed by radical surgery may provide another treatment option.Primary objectiveTo compare the therapeutic outcomes of neoadjuvant chemotherapy followed by surgery with cisplatin-based concurrent chemoradiotherapy for stage IIB cervical cancer.Study hypothesisWe hypothesize that the therapeutic effect of neoadjuvant chemotherapy combined with surgery and risk-adapted adjuvant treatment will be superior to that of concurrent chemoradiotherapy in stage IIB cervical cancer.Trial designPatients with stage IIB cervical cancer will be randomized 1:1 to neoadjuvant chemotherapy followed by surgery (Arm A) or concurrent chemoradiotherapy (Arm B). In arm A, patients will receive three cycles of paclitaxel and cisplatin followed by a type C radical hysterectomy and pelvic ±paraaortic lymphadenectomy. Patients showing progression after neoadjuvant chemotherapy will be referred to concurrent chemoradiotherapy. Adjuvant therapy will be recommended according to the presence of pathological risks. In Arm B, all patients will receive definitive concurrent chemoradiotherapy, including external beam pelvic radiotherapy combined with concurrent weekly cisplatin followed by brachytherapy.Major inclusion/exclusion criteriaPatients between 18 and 60 years with histologically confirmed, untreated stage IIB cervical squamous carcinoma, adenocarcinoma, or adeno-squamous carcinoma.Primary endpointThe primary endpoint is 2-year disease-free survival.Sample sizeAn estimated sample size of 240 is required to fulfill the study objectives.Estimated dates for completing accrual and presenting resultsAs of February 2020, 115 eligible patients from four institutions have been enrolled. Enrollment is expected to be completed by December 2022.Trial registration numberClinicalTrials. gov identifier: NCT02595554.

Is Neoadjuvant Chemotherapy Followed by Radical Surgery More Effective Than Radiation Therapy for Stage IIB Cervical Cancer?

2013 ◽  
Vol 23 (7) ◽  
pp. 1303-1310 ◽  
Author(s):  
Dae Woo Lee ◽  
Keun Ho Lee ◽  
Jung Won Lee ◽  
Sung Taek Park ◽  
Jong Sup Park ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Prognostic Factors ◽  
Neoadjuvant Chemotherapy ◽  
Patient Survival ◽  
Radical Surgery ◽  
Therapy Group ◽  
Disease Free Survival ◽  
Free Survival ◽  
Disease Free

ObjectiveThe primary objective of the study was to compare the survival rate of patients who had received neoadjuvant chemotherapy with that of patients who had received radiation therapy for stage IIB cervical cancer. The secondary objective was to analyze the effect of neoadjuvant chemotherapy on pathological prognostic factors.Materials and MethodsWe retrospectively reviewed the medical records of patients who had received therapy for stage IIB cervical cancer. Based on the primary therapy, 192 patients were divided into 2 groups; patients in the neoadjuvant chemotherapy group (n =103) underwent a type III radical hysterectomy after completion of the neoadjuvant chemotherapy. Patients in the other group (n = 89) were treated with radiation alone or a combination of chemotherapy and radiotherapy.ResultsAfter neoadjuvant chemotherapy, the level of squamous cell carcinoma antigen, tumor size, lymph node involvement, and parametrium involvement were significantly decreased. However, 90.3% of the patients who had received neoadjuvant chemotherapy needed to have adjuvant therapy after radical surgery because of poor pathological prognostic factors. The rate of disease-free survival did not differ significantly between the 2 groups. However, the overall survival rate was significantly lower in the neoadjuvant chemotherapy group for patients who were 60 years or older (P = 0.03). The rates of disease-free survival and overall survival for patients who had a good (complete or partial) response to the neoadjuvant chemotherapy were not significantly higher than the rates for patients in the radiation therapy group.ConclusionsAlthough neoadjuvant chemotherapy improved pathological prognostic factors in patients with stage IIB cervical cancer, it was not sufficiently effective to decrease adjuvant therapy. Neoadjuvant chemotherapy also did not improve the rate of patient survival compared to the rate of patient survival in the radiation therapy group.

scholarly journals Association of Three Micro-RNA Gene Polymorphisms with the Risk of Cervical Cancer: A Meta-Analysis and Systematic Review

2021 ◽  
Author(s):  
Jingyu Xu ◽  
Yihua Fan ◽  
Qiang Zhang ◽  
Junze Geng ◽  
Tian Xia
Keyword(s):  
Cervical Cancer ◽  
Cancer Susceptibility ◽  
Meta Analysis ◽  
Recessive Model ◽  
Micro Rna ◽  
Host Cells ◽  
Cochrane Library ◽  
Cancer Case ◽  
Case Control Studies ◽  
Reduced Risk

Abstract Objective: Regulation of single nucleotide polymorphisms (SNP) in micro-RNA ( miRNA) on the host cells may be one of the most important factors influencing the occurrence of cervical cancer based on the prevalence of HPV infection and the development of cervical cancer. In order to explore the contribution of miRNA polymorphism to the occurrence and development of cervical cancer, we conducted an analytical study. Methods: We selected the polymorphisms of three widely studied miRNAs (miRNA-146a rs2910164, miRNA-499 rs3746444 and miRNA-196a2 rs11614913). Then we conducted a meta-analysis (for the first time) to investigate their susceptibility to cervical cancer. Case control studies on the correlation between these three miRNAs and cervical cancer susceptibility were investigated by searching on from Pubmed, The Cochrane Library, Embase, CBM, CNKI, Wanfang database and VIP database. Basic characteristics were recorded and meta-analysis of the case studies was performed using STATA 15.1 software. Results: The miRNA-146a rs2910164 mutation significantly reduced the risk of cervical cancer in both recessive model (OR= 0.804, 95%CI= 0.652-0.992, P= 0.042；CC vs. CG+GG) and allelic model (OR= 0.845, 95%CI= 0.721-0.991, P= 0.038；C vs. G). There was no significant correlation between miRNA -499 rs3746444 and the risk of cervical cancer. The miRNA -196a2 rs11614913 mutation was significantly associated with a reduced risk of cervical cancer in homozygous model (OR= 0.641, 95%CI= 0.447-0.919, P= 0.016；TT vs. CC), dominant model (OR= 0.795, 95%CI= 0.636-0.994, P= 0.045；CT+TT vs. CC), recessive model (OR= 0.698, 95%CI= 0.532-0.917, P= 0.01；TT vs. CC+CT), and allelic models (OR= 0.783, 95%CI= 0.643-0.954, P= 0.015；T vs. C). Conclusion: In summary, this meta-analysis shows that the mutant genotypes of miRNA -146a rs2910164 and miRNA -196a2 rs11614913 are associated with a reduced risk of cervical cancer. Therefore, they may be two gene regulatory points for the prevention of cervical cancer.

scholarly journals Effect of neoadjuvant chemotherapy followed by surgery for FIGO stage I–II cervical cancer: a meta-analysis

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094550
Author(s):  
Shu-Li Yang ◽  
Ling Chen ◽  
Yue He ◽  
Hui Zhao ◽  
Yu-Mei Wu
Keyword(s):  
Cervical Cancer ◽  
Survival Rate ◽  
Neoadjuvant Chemotherapy ◽  
Radical Surgery ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Figo Stage ◽  
Stage I ◽  
Oncological Outcomes ◽  
Gynecology And Obstetrics

Objective In this meta-analysis, we aimed to evaluate the oncological outcomes of preoperative neoadjuvant chemotherapy followed by radical surgery compared with radical surgery alone for treatment of International Federation of Gynecology and Obstetrics (FIGO) stage I–II cervical cancer. Method We searched for studies comparing the safety and efficacy of neoadjuvant chemotherapy plus surgery versus surgery alone in treatment outcomes of locally advanced cervical cancer. Meta-analysis was used to calculate the pooled odds ratios with corresponding 95% confidence intervals (CI). Results Sixteen studies were included in our analysis. Pooled analysis of overall survival rate [odds ratio (OR) = 1.09, 95% CI: 0.83–1.43] and progression-free survival rate (OR = 1.10, 95% CI: 0.77–1.57) showed that preoperative neoadjuvant chemotherapy did not have a benefit compared with surgery alone in terms of survival rates. The pooled results for postoperative parameters indicated that preoperative neoadjuvant chemotherapy followed by radical surgery was associated with a high rate of vascular space involvement (OR = 0.25, 95% CI: 0.17–0.35) and parametrial infiltration (OR = 0.60, 95% CI: 0.45–0.79). Conclusions This meta-analysis indicated that surgery following neoadjuvant chemotherapy for FIGO stage I–II cervical cancer and surgery alone had similar oncological outcomes.

scholarly journals Comparison of therapeutic effects of chemo-radiotherapy with neoadjuvant chemotherapy before radical surgery in patients with bulky cervical carcinoma (stage IB3 & IIA2)

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Setareh Akhavan ◽  
Abbas Alibakhshi ◽  
Mahdieh Parsapoor ◽  
Abbas Alipour ◽  
Elahe Rezayof
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Medical Records ◽  
Primary Outcome ◽  
Disease Free Survival ◽  
Therapeutic Effects ◽  
Cancer Stage ◽  
Free Survival ◽  
Disease Free ◽  
Timely Treatment

Abstract Background Cervical cancer is one of the most common malignancies among women. Appropriate and timely treatment of these patients can reduce the complications and increase their survival. The objective of this study was to compare neoadjuvant chemotherapy plus radical hysterectomy (NACTRH) and chemo-radiotherapy (CRT) in patients with bulky cervical cancer (stage IB3 & IIA2). Material and methods The medical records of patients with bulky cervical cancer (stage IB3 & IIA2) that received NACTRH or CRT between 2007 and 2017 were evaluated for therapeutic effects. Demographic characteristics, complications of chemo-radiotherapy and neoadjuvant chemotherapy, were collected in a researcher-made questionnaire. Our primary outcome was comparison of overall survival (OS), and disease-free survival (DFS) between two groups receiving NACTRH and CRT modalities. Results One-hundred and twenty three patients were enrolled in the study. The median age and the proportion of patients with stage IIA2 were higher in the CRT group compared to the NACTRH group (p < 0.05). The medians (95% CI) OS were 3.64 (3.95–6.45) and 3.9 (3.53–4.27) years in the NACTRH and CRT groups, respectively (P = 0.003). There were 16 (34.8%) and 22 (43.1%) recurrences in the NACTRH and CRT group, respectively (P = 0.4). The median (95% CI) DFS was 4.5 (3.88–5.12) years in the NACTRH group and 3.6 (2.85–4.35) years in the CRT group (P = 0.004). The 3-year OS rate in NACTRH and CRT groups were 97 and 90% respectively. The 3-year DFS rate in NACTRH and CRT groups were 88 and 66% respectively. Conclusions NACTRH is associated with a higher OS and DFS compared to CRT.

scholarly journals Association of Three micro-RNA Gene Polymorphisms with the Risk of Cervical Cancer: A Meta-Analysis and Systematic Review

2021 ◽  
Author(s):  
Jingyu Xu ◽  
Yihua Fan ◽  
Qiang Zhang ◽  
Junze Geng ◽  
Tian Xia
Keyword(s):  
Cervical Cancer ◽  
Cancer Susceptibility ◽  
Meta Analysis ◽  
Recessive Model ◽  
Micro Rna ◽  
Host Cells ◽  
Cochrane Library ◽  
Cancer Case ◽  
Case Control Studies ◽  
Reduced Risk

Abstract Objective: Regulation of single nucleotide polymorphisms (SNP) in micro-RNA (miRNA) on the host cells may be one of the most important factors influencing the occurrence of cervical cancer based on the prevalence of HPV infection and the development of cervical cancer. In order to explore the contribution of miRNA polymorphism to the occurrence and development of cervical cancer, we conducted an analytical study. Methods: We selected the polymorphisms of three widely studied miRNAs (miRNA-146a rs2910164, miRNA-499 rs3746444 and miRNA-196a2 rs11614913). Then we conducted a meta-analysis (for the first time) to investigate their susceptibility to cervical cancer. Case control studies on the correlation between these three miRNAs and cervical cancer susceptibility were investigated by searching on from Pubmed, The Cochrane Library, Embase, CBM, CNKI, Wanfang database and VIP database. Basic characteristics were recorded and meta-analysis of the case studies was performed using STATA 15.1 software. Results: The miRNA-146a rs2910164 mutation significantly reduced the risk of cervical cancer in both recessive model (OR= 0.804, 95%CI= 0.652-0.992, P= 0.042；CC vs. CG+GG) and allelic model (OR= 0.845, 95%CI= 0.721-0.991, P= 0.038；C vs. G). There was no significant correlation between miRNA -499 rs3746444 and the risk of cervical cancer. The miRNA -196a2 rs11614913 mutation was significantly associated with a reduced risk of cervical cancer in homozygous model (OR= 0.641, 95%CI= 0.447-0.919, P= 0.016；TT vs. CC), dominant model (OR= 0.795, 95%CI= 0.636-0.994, P= 0.045；CT+TT vs. CC), recessive model (OR= 0.698, 95%CI= 0.532-0.917, P= 0.01；TT vs. CC+CT), and allelic models (OR= 0.783, 95%CI= 0.643-0.954, P= 0.015；T vs. C). Conclusion: In summary, this meta-analysis shows that the mutant genotypes of miRNA -146a rs2910164 and miRNA -196a2 rs11614913 are associated with a reduced risk of cervical cancer. Therefore, they may be two gene regulatory points for the prevention of cervical cancer.PROSPERO Registration number: CRD42021270079.

Comparison of Radical Surgery and Radiotherapy for the Treatment of Early-Stage Cervical Carcinoma: A Meta-Analysis

2021 ◽  
Vol 44 (4) ◽  
pp. 161-168
Author(s):  
Huixiang Wang ◽  
Chengxiang Ni ◽  
Wei Xiao ◽  
Tonglei Yang ◽  
Wei Sun
Keyword(s):  
Adverse Events ◽  
Cervical Carcinoma ◽  
Large Scale ◽  
Radical Surgery ◽  
Early Stage ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Free Survival ◽  
Hazard Ratios ◽  
Risk Ratios

Objective: To compare the efficacy and safety of radical surgery with radiotherapy in patients with early-stage cervical carcinoma. Methods: PubMed, Web of Science, and Embase were systematically reviewed, and studies comparing radical surgery with radiotherapy were included. The main efficacy outcomes included overall survival (OS), and disease-free survival (DFS). Safety endpoints were adverse events. Hazard ratios (HR) or risk ratios (RR) with 95% CI were used to pool the estimates. Results: A total of 6 studies were included in this meta-analysis. Radical surgery was associated with comparable survival effects in OS (HR = 0.73; 95% CI 0.46–1.17; p = 0.196) and DFS (HR = 0.84; 95% CI 0.64–1.10; p = 0.207) as compared with radiotherapy. Moreover, positive lymphangiography (HR = 3.67; 95% CI 2.86–4.70; p < 0.001), adeno-carcinomatous histotype (HR = 2.53; 95% CI 1.80–3.56; p < 0.001), adenosquamous histotype (HR = 1.55; 95% CI 1.27–1.89; p < 0.001), tumor size ≥4 cm (HR = 1.60; 95% CI 1.14–2.23; p < 0.001), stage IB2 (HR = 1.71; 95% CI 1.43–2.04; p < 0.001), and stage IIA (HR = 1.85; 95% CI 1.54–2.22; p < 0.001) were all independent predictors of decreased survival. Patients treated with radical surgery had a rate of adverse events similar to that of those treated with radiotherapy (RR = 1.23; 95% CI 0.61–2.48; p = 0.557). Conclusion: The present study suggested that radical surgery and radiotherapy offered similarly effective treatment in terms of OS and DFS in early-stage cervical carcinoma. Moreover, the complication rate between the 2 treatments was not significantly different. Considering the potential limitations of this study, more large-scale well-designed randomized controlled trials are needed to verify our findings.

scholarly journals STAGE IB2–IIIB CERVICAL CANCER: NEOADJUVANT CHEMOTHERAPY, RADICAL SURGERY AND PATIENT SURVIVAL

2021 ◽  
Vol 20 (3) ◽  
pp. 82-89
Author(s):  
D. L. Ovodenko ◽  
G. N. Khabas ◽  
Yu. M. Kreinina ◽  
A. A. Seregin ◽  
O. I. Aleshikova ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Survival Rate ◽  
Neoadjuvant Chemotherapy ◽  
Radical Surgery ◽  
Disease Free Survival ◽  
Cytostatic Drugs ◽  
Free Survival ◽  
Long Term Treatment ◽  
Disease Free

 The aim of the study was to evaluate the five-year survival rate in patients with stage ib2–iiib cervical cancer treated with neoadjuvant chemotherapy and radical surgery.Material and Methods. Long-term treatment outcomes were studied in 173 patients with histologically-verified stage ib2–iiib cervical squamous cell carcinoma. The patients underwent neoadjuvant chemotherapy using intravenous infusion of cytostatic drugs (n=106) and intra-arterial infusion of cytostatic drugs in combination with embolization of tumor-feeding arteries (n=67). Patients with resectable tumors underwent radical surgery. Disease-free survival was assessed.Results. The median follow-up time was 66 months, and the maximum follow-up period was 144 months. 160 (92.5 %) patients underwent radical surgery after chemotherapy. 55 (34.4 %) patients did not receive adjuvant radiation therapy. The five-year disease-free survival rate was 79.6 %.Conclusion. For the group of patients with locally advanced cervical cancer, who achieved respectability following neoadjuvant chemotherapy, radical surgery could be performed. Chemotherapy followed by radical surgery can improve disease-free survival rates in patients with stage ib2–iiib cervical cancer.

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