Document Type : Systematic Review and Meta-analysis
Authors
1
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
2
Department of Obstetrics and Gynecology, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
3
School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Penjaringan, North Jakarta, Daerah Khusus Ibukota Jakarta, Indonesia.
Abstract
Introduction: This systematic review and meta-analysis assessed the efficacy and safety of neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy (CCRT) compared to CCRT alone in locally advanced cervical cancer (LACC). Methods: We systematically searched PubMed, ScienceDirect, Cochrane Library, EBSCOHost, ProQuest, and grey literature (Google Scholar, OpenGrey, WorldCat) up to April 26, 2024 (PROSPERO: [CRD42024540599]). Seven studies were included (stages IB2–IVA, FIGO 2018), involving 446 participants. Outcomes included complete response (CR), progression-free survival (PFS), overall survival (OS), and adverse effects. Results: Seven studies were included (n = 1,638), with 825 patients receiving NACT+CCRT and 813 receiving CCRT alone. The NACT+CCRT group showed higher CR rates (77% vs. 70.9%), but the difference was not statistically significant (OR 1.23, 95% CI 0.40–3.83). No significant differences were found in PFS (HR 0.94, 95% CI 0.53–1.69) or OS (HR 1.07, 95% CI 0.56–2.03). Adverse effects, including anemia, neutropenia, thrombocytopenia, nausea, vomiting, fatigue, and creatinine elevation, showed no significant differences between the groups. Conclusion: In patients with locally advanced cervical cancer, NACT followed by CCRT is associated with comparable survival outcomes and a similar safety profile to standard CCRT, with a non-significant trend toward improved CR.
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