Radiotherapy with concurrent cisplatin-based doublet or weekly cisplatin for cervical cancer: A systematic review and meta-analysis

Background. Treatment with weekly cisplatin (CDDP) plus radiotherapy (RT) is the standard regimen for stage IB to stage IVA cervical carcinoma (CC). We performed a systematic review and meta-analysis of published studies to evaluate whether CDDP-based doublet therapy improves survival compared to weekly CDDP plus RT in patients with CC. Materials and methods. We conducted a systematic search for randomized and nonrandomized studies in PubMed, EMBASE, Web of Science, Scopus, and the Cochrane Register of Controlled Trials. We then carried out a meta-analysis by using the fixed- or random-effects models. The primary endpoints were overall survival (OS) and progression-free survival (PFS), reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results. Four randomized trials and 4 retrospective studies that included a total of 1500 patients matched our selection criteria. Meta-analysis showed that for locally advanced CC, concurrent RT and with CDDP-based doublet chemotherapy significantly improved the OS (OR, 0.65; 95% CI, 0.51-0.81; p = 0.0002), PFS (OR, 0.71; 95% CI, 0.55-0.91; p = 0.006), and rate of locoregional relapse (OR, 0.64; 95% CI, 0.47-0.89; p = 0.008), compared to RI with concurrent weekly CDDP alone. Conclusions. In patients with CC, platinum-based doublet chemotherapy plus concurrent RT was associated with improvements in the OS and PFS of 35% and 30% patients, respectively, compared to RT plus weekly CDDP. Therefore, platinum-based combination therapy plus RT should be the preferred treatment over weekly CDDP plus RT for stage IB-IVA CC. (C) 2014 Elsevier Inc. All rights reserved.