Comparison between curative concurrent chemoradiotherapy followed by adjuvant chemotherapy and curative concurrent chemoradiotherapy alone in patients with locally advanced cervical carcinoma: a meta-analysis

Objective: In the studies of locally advanced cervical carcinoma (LACC), the efficacy of adjuvant chemotherapy (ACT) after curative concurrent chemoradiotherapy (CCRT) has not been clearly investigated. This paper aimed to evaluate the impact of CCRT followed by ACT compared with the impact of CCRT alone in the treatment of LACC. Data sources, methods of study selection: The Web of Science, Cochrane Library, EM BASE, and PubMed were systematically reviewed to find eligible studies up to 28 February 2020. The pooled analysis was conducted through random- or fixed-effect models. Clinical endpoints such as overall survival (OS), progression-free survival (PFS), local failure rate (LFR), distant metastasis (DM), as well as adverse events (AEs) were examined as evaluation indexes. Tabulation, integration and results: Three retrospective studies and two randomized trials were enrolled in this meta-analysis comprising 1172 patients (CCRT arm: 588; CCRT + ACT arm: 584). No significant differences were discovered in OS (hazard ratio [HR] = 0.94, 95% confidence interval [CI]: 0.46,1.94, p = 0.88) and PFS (HR = 0.91, 95% CI: 0.50,1.67, p = 0.76) between CCRT followed by ACT and CCRT alone. The pooled RRs for LFR (RR = 0.64, 95% CI: 0.44, 0.92, p = 0.02) and DM (RR = 0.50, 95% CI: 0.35, 0.71, p < 0.05) showed that the application of CCRT followed by ACT decreased LFR and DM compared with CCRT alone. However, CCRT followed by ACT arm had more acute hematologic toxicities (anemia, neutropenia, thrombocytopenia) and grade 3-4 proctitis (all p < 0.05), than CCRT arm; no statistic differences were found in late toxicities (cystitis and proctitis) between the two arms (p > 0.05). Conclusion: This study suggested that CCRT followed by ACT did not prolong OS and PFS. It decreased LFR and DM compared with CC RT alone. CCRT followed by ACT raised the incidence of acute hematologic toxicities and proctitis but did not increase late toxicities. Further study is needed in CCRT followed ACT for LACC.