Induction chemotherapy followed by chemoradiotherapy for locally advanced cervical cancer: A systematic review and meta-analysis
The addition of induction chemotherapy (ICT) prior to concomitant chemoradiotherapy (CCRT) in the treatment of locally advanced cervical cancer (LACC) is controversial, as trials have yielded conflicting results. This study aims to evaluate the role of ICT followed by CCRT in LACC. We systematically searched PubMed, Embase and Cochrane for studies with patients diagnosed with LACC receiving ICT followed by CCRT. Studies that included surgery, definitive radiotherapy (without concurrent chemotherapy), or immunotherapy were excluded. Among 5,282 screened studies, 20 met the inclusion criteria, representing 1,543 patients treated with ICT. A meta-analysis of the five controlled studies exhibited high heterogeneity in progression-free survival (PFS) and overall survival (OS), driven by the CIRCE trial - a study employing a platinum-gemcitabine ICT regimen lasting > 6 weeks. Sensitivity analysis excluding this trial demonstrated a significant improvement in PFS (HR 0.46; 95 % CI 0.31-0.69; p = 0.0002) and OS (HR 0.68; 95 % CI 0.47-0.99; p = 0.049) with the addition of ICT to CCRT, compared to CCRT alone. Meta-analysis of proportions revealed a 2-year OS of 84.1 % for studies utilizing platinum-paclitaxel compared to 72.2 % for platinum-gemcitabine (p-value for subgroup difference = 0.022). Studies with ICT duration of ≤ 6 weeks showed a 2-year OS of 84.8 % compared to 71.7 % for ICT duration > 6 weeks (p = 0.003). In patients with LACC, ICT + CCRT significantly improves PFS and OS compared to CCRT alone, provided that the ICT involves a platinum doublet with paclitaxel and is administered within ≤ 6 weeks.