The Application Of Different Drugs In The Sensitization Of Radical Radiotherapy For Advanced Cervical Cancer:a Network Meta-analysis

Objective:The efficacy and adverse reactions of different drugs in radical radiotherapy sensitization of advanced cervical cancer were compared,and in order to find out a more reasonable sensitization scheme,provide the best radiotherapy sensitization drugs for clinic,and provide evidence-based basis for clinical individualized treatment.Methods:The Chinese databases(CNKI,Wanfang,VIP,Sino Med)and English databases(Pubmed,Embase,Cochrane library)were searched by computer from January 2001 to June 2021.Relevant randomized controlled trials at home and abroad were collected according to the inclusion and exclusion standards.Cochrane risk bias assessment tool and Rev Man 5.4 were used to evaluate the quality of the included documents that met the inclusion criteria.After data extraction,Stata 15.1 was used for network meta-analysis.The efficacy and safety of 17 drug sensitization treatment schemes were compared directly and indirectly,and the probability ranking was carried out according to the efficacy and safety.Results:A total of 43 articles were included in this paper,including 3676 patients with cervical cancer,involving 17 different sensitizing treatment schemes,including cisplatin,nedaplatin,carboplatin,lobaplatin,paclitaxel,docetaxel,paclitaxel liposome,cisplatin+5-FU,cisplatin+docetaxel(docetaxel),cisplatin+endostar,cisplatin+ paclitaxel,cisplatin+gemcitabine and cisplatin+gemcitabine.Among them,there are 17 sensitizing schemes related to the total clinical effective rate.According to the results of mesh meta-analysis and SUCRA ranking diagram,cisplatin+paclitaxel liposome may be the best sensitizing scheme,followed by nedaplatin+5-FU,cisplatin+endostar,cisplatin+retirexed,etc.There are 12 sensitization schemes related to the occurrence of gastrointestinal toxicity.According to the mesh meta-analysis results and probability ranking diagram,nedaplatin has the lowest incidence of gastrointestinal toxicity,followed by paclitaxel,lobaplatin,cisplatin+paclitaxel liposome,etc.There are 13 sensitization schemes related to the occurrence of myelosuppression,only nedaplatin+5-FU is statistically significant compared with nedaplatin+paclitaxel.According to SUCRA table,nedaplatin+5-FU has the lowest incidence of myelosuppression,followed by paclitaxel,docetaxel,cisplatin+paclitaxel liposome,etc.There are six sensitization schemes related to leukopenia.According to reticular meta-analysis results and SUCRA,paclitaxel liposome has the lowest incidence of leukopenia,followed by cisplatin+endostar,cisplatin,nedaplatin,etc.There are seven sensitization schemes related to thrombocytopenia.The mesh meta-analysis results and SUCRA ranking table show that paclitaxel liposome may be the lowest on-time rate of thrombocyt-openia,followed by carboplatin,cisplatin+endostar,cisplatin,etc.There are 9 sensitization schemes involving anemia and renal damage,and there is no statistical significance between every two sensitization schemes for anemia.Among all sensitization schemes for renal damage,except that compared with cisplatin,nedaplatin and lobaplatin can reduce the incidence of renal damage,there is no statistical significance between every two sensitization schemes,according to the SUCRA ranking of anemia,the incidence of carboplatin anemia is the lowest,followed by nedaplatin+paclitaxel,cisplatin+paclitaxel,cisplatin+endostar,etc.The order of renal damage SUCRA is: docetaxel has the lowest incidence of renal damage,followed by lobaplatin,nedaplatin,cisplatin+endostar,etc.There are 9 sensitization schemes related to 1-year survival rate,4 sensitization schemes for 4-year survival rate,and there is no statistical significance between every two sensitization schemes for 1-year and 4-year survival rate,according to the SUCRA ranking,the 1-year and 4-year survival rates of cisplatin+docetaxel are the highest.There are 10 sensitization schemes involving the 3-year survival rate.According to the results of network meta-analysis and SUCRA ranking chart,the survival rate of cisplatin+docetaxel is the highest,followed by cisplatin+paclitaxel liposome,cisplatin+retirexed,carboplatin,etc.The sensitization schemes involving 4 years of local recurrence and distant metastasis are the same,including 4 sensitization schemes.The network meta-analysis shows that there is no statistical significance among the sensitization schemes,according to the SUCRA ranking,the local recurrence rate of cisplatin+docetaxel at 4 years is the lowest,followed by docetaxel,paclitaxel and cisplatin,and the distant metastasis of paclitaxel at 4 years is the lowest,followed by docetaxel,cisplatin+docetaxel and cisplatin.Conclusion:Cisplatin+paclitaxel liposome may be the best drug scheme for radiosensiti-zation of advanced cervical cancer,and the incidence of gastrointestinal toxicity and myelosuppression is low.The 1-,3-and 4-year survival rate of cisplatin plus docetaxel is probably the highest among these schemes.