Role Of Adjuvant Chemotherapy After Concurrent Chemoradiation For Locally Advanced Cervical Cancer

Background: To date,concurrent chemoradiation therapy(CCRT)has been recommended as standard therapy for patients with locally advanced cervical cancer(LACC).However,survival benefit is still unsatisfactory and the optimal treatment is still being explored.This meta-analysis aimed to evaluate efficacy and safety of adjuvant chemotherapy(ACT)after CCRT for patients with LACC.Methods: Relevant randomized controlled trials(RCTs)were included through PubMed,Cochrane Library,EMBASE,clinicaltrial.gov and Web of Science from up to May 2019.The overall survival(OS),progression-free survival(PFS)/disease-free survival(DFS),local failure rate(LFR),distant failure rate(DFR)and adverse reactions were summarized by hazard ratio(HR)or risk ratio(RR).Results: Four RCTs involving 2117 patients were identified.Although ACT after CCRT showed no significance in OS(HR=0.91,95%CI=0.65–1.27),DFS/PFS(HR=0.89,95% CI=0.67–1.18),and LFR(HR=0.79,95% CI=0.53–1.17)compared with CCRT alone,DFR was significantly decreased with the appliance of ACT(HR=0.67,95%CI=0.46–0.99).In terms of safety,ACT was associated with a tendency of higher risk of myelosuppression(RR=2.51,95% CI=1.03-6.10),nausea and vomiting(RR=1.61,95% CI=0.85-3.04),and diarrhea(RR=2.01,95% CI=0.84-4.81),even though statistic difference was only found in myelosuppression.Conclusion: The application of ACT after CCRT can reduce DFR in patients with LACC,but has no benefits of OS and PFS/DFS.Evidence is inadequate to support the appliance of ACT after CCRT for LACC patients.Further research is needed to study this topic.