The Efficacy And Safety Of Neoadjuvant Chemotherapy Combined With Concurrent Chemoradiotherapy In The Treatment Of Locally Advanced Cervical Cancer-a Meta Analysis

Objective: We expected to seek a more effective treatment for locally advanced cervical cancer,and provide theoretical basis for clinical treatment.We performed a meta-analysis of clinical trials directly comparing neoadjuvant chemotherapy combined with concurrent chemoradiotherapy versus chemoradiotherapy alone to evaluate the effectiveness and safety of the two treatment choices in locally advanced cervical cancer patients.Methods:Databases including Pub Med,Embase,The Cochrane Library,Web of Science,CNKI,CBM and Wan Fang Data were searched,and the references were retrospectively reviewed.Inclusion criteria included studies about neoadjuvant chemotherapy in cervical cancer patients before October 2016,languages was restricted to Chinese and English.According to the inclusion and exclusion criteria,all eligible documents were assessed for quality and extracted data were performed by a meta-analysis.The quality of study about randomized controlled trials(RCT)were evaluated with the modified Jadad scale,while Clinical control trial(CCT)were evaluated with Newcastle-Ottawa Scale(NOS),the statistical analysis was performed using Review Manager 5.3 software.The outcomes of interest were complete response(CR),objective response rate(ORR),overall survival(OS),disease-free survival(DFS),and incidence of adverse events.Results:Data were collected from 2229 patients enrolled in 8 studies,3 RCT trials and 5CCT trials,Published from 2012 to 2016.meta-analysis showed that:(1)Compared with the chemoradiotherapy alone group,the NACT group was superior in improving the complete response(CR)and objective response rate(ORR),CR[OR=1.85,95%CI:1.42~2.42,P<0.00001],ORR[OR=2.48,95%CI:1.39~4.41,P=0.002].(2)Neoadjuvant chemotherapy didnot improve the survival rate of patients,1-year OS[OR=6.65,95%CI:0.54~82.08,P=0.14],3-year OS[OR=1.58,95%CI:0.76~3.30,P=0.22],5-year OS[OR=1.44,95%CI:0.74~2.78,P=0.28],there were no significant differences between the two groups.However,this treatment strategy increased 3 years and 5 years DFS,3-year DFS[OR=1.69,95%CI:1.09~2.62,P=0.02],5-year DFS[OR=0.17,95%CI:0.11~0.24,P<0.00001].(3)The toxic reaction had no significant difference between the two groups,bone marrow suppression [OR=0.43,95%CI:0.20~0.92,P=0.03],digestive tract reaction[OR=1.12,95%CI:0.58~2.16,P=0.84],neurotoxicity [OR=0.43,95%CI:0.09~2.02,P=0.93].The toxic reaction was similar in the two groups.Conclusion: The conclusion of our study is that in the treatment of locally advanced cervical cancer,neoadjuvant chemotherapy combined concurrent chemoradiotherapy can increase the short-term remission rate and disease-free survival rate,but it is not helpful to improve overall survival rate and reduce the incidence of side effects.