Radiotherapy and chemoradiation after surgery for early cervical cancer
Identifieur interne : 003436 ( Pmc/Curation ); précédent : 003435; suivant : 003437Radiotherapy and chemoradiation after surgery for early cervical cancer
Auteurs : Linda Rogers [Afrique du Sud] ; Shing Shun N. Siu [République populaire de Chine] ; David Luesley [Royaume-Uni] ; Andrew Bryant [Royaume-Uni] ; Heather O. Dickinson [Royaume-Uni]Source :
- The Cochrane database of systematic reviews [ 1469-493X ] ; 2012.
Abstract
This is an updated version of the original Cochrane review first published in Issue 4, 2009. There is an ongoing debate about the indications for, and value of, adjuvant pelvic radiotherapy after radical surgery in women with early cervical cancer. Certain combinations of pathological risk factors are thought to represent sufficient risk for recurrence, that they justify the use of postoperative pelvic radiotherapy, though this has never been shown to improve overall survival, and use of more than one type of treatment (surgery and radiotherapy) increases the risks of side effects and complications.
To evaluate the effectiveness and safety of adjuvant therapies (radiotherapy, chemotherapy followed by radiotherapy, chemoradiation) after radical hysterectomy for early-stage cervical cancer (FIGO stages IB1, IB2 or IIA).
For the original review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 4, 2008. The Cochrane Gynaecological Cancer Group Trials Register, MEDLINE (January 1950 to November 2008), EMBASE (1950 to November 2008). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. For this update, we extended the database searches to September 2011 and searched the MetaRegister for ongoing trials.
Randomised controlled trials (RCTs) that compared adjuvant therapies (radiotherapy, chemotherapy followed by radiotherapy, or chemoradiation) with no radiotherapy or chemoradiation, in women with a confirmed histological diagnosis of early cervical cancer who had undergone radical hysterectomy and dissection of the pelvic lymph nodes.
Two review authors independently abstracted data and assessed risk of bias. Information on grade 3 and 4 adverse events was collected from the trials. Results were pooled using random-effects meta-analyses.
Two RCTs, which compared adjuvant radiotherapy with no adjuvant radiotherapy, met the inclusion criteria; they randomised and assessed 397 women with stage IB cervical cancer. Meta-analysis of these two RCTs indicated no significant difference in survival at 5 years between women who received radiation and those who received no further treatment (risk ratio (RR) = 0.8; 95% confidence interval (CI) 0.3 to 2.4). However, women who received radiation had a significantly lower risk of disease progression at 5 years (RR 0.6; 95% CI 0.4 to 0.9).
Although the risk of serious adverse events was consistently higher if women received radiotherapy rather than no further treatment, these increased risks were not statistically significant, probably because the rate of adverse events was low.
We found evidence, of moderate quality, that radiation decreases the risk of disease progression compared with no further treatment, but little evidence that it might improve overall survival, in stage IB cervical cancer. The evidence on serious adverse events was equivocal.
Url:
DOI: 10.1002/14651858.CD007583.pub3
PubMed: 22592722
PubMed Central: 4171000
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<author><name sortKey="Rogers, Linda" sort="Rogers, Linda" uniqKey="Rogers L" first="Linda" last="Rogers">Linda Rogers</name>
<affiliation wicri:level="1"><nlm:aff id="A1">Department of Obstetrics and Gynaecology, H Floor Old Main Building, Observatory, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
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<author><name sortKey="Siu, Shing Shun N" sort="Siu, Shing Shun N" uniqKey="Siu S" first="Shing Shun N" last="Siu">Shing Shun N. Siu</name>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P5">This is an updated version of the original Cochrane review first published in Issue 4, 2009. There is an ongoing debate about the indications for, and value of, adjuvant pelvic radiotherapy after radical surgery in women with early cervical cancer. Certain combinations of pathological risk factors are thought to represent sufficient risk for recurrence, that they justify the use of postoperative pelvic radiotherapy, though this has never been shown to improve overall survival, and use of more than one type of treatment (surgery and radiotherapy) increases the risks of side effects and complications.</p>
</sec>
<sec id="S2"><title>Objectives</title>
<p id="P6">To evaluate the effectiveness and safety of adjuvant therapies (radiotherapy, chemotherapy followed by radiotherapy, chemoradiation) after radical hysterectomy for early-stage cervical cancer (FIGO stages IB1, IB2 or IIA).</p>
</sec>
<sec id="S3"><title>Search methods</title>
<p id="P7">For the original review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 4, 2008. The Cochrane Gynaecological Cancer Group Trials Register, MEDLINE (January 1950 to November 2008), EMBASE (1950 to November 2008). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. For this update, we extended the database searches to September 2011 and searched the MetaRegister for ongoing trials.</p>
</sec>
<sec id="S4"><title>Selection criteria</title>
<p id="P8">Randomised controlled trials (RCTs) that compared adjuvant therapies (radiotherapy, chemotherapy followed by radiotherapy, or chemoradiation) with no radiotherapy or chemoradiation, in women with a confirmed histological diagnosis of early cervical cancer who had undergone radical hysterectomy and dissection of the pelvic lymph nodes.</p>
</sec>
<sec id="S5"><title>Data collection and analysis</title>
<p id="P9">Two review authors independently abstracted data and assessed risk of bias. Information on grade 3 and 4 adverse events was collected from the trials. Results were pooled using random-effects meta-analyses.</p>
</sec>
<sec id="S6"><title>Main results</title>
<p id="P10">Two RCTs, which compared adjuvant radiotherapy with no adjuvant radiotherapy, met the inclusion criteria; they randomised and assessed 397 women with stage IB cervical cancer. Meta-analysis of these two RCTs indicated no significant difference in survival at 5 years between women who received radiation and those who received no further treatment (risk ratio (RR) = 0.8; 95% confidence interval (CI) 0.3 to 2.4). However, women who received radiation had a significantly lower risk of disease progression at 5 years (RR 0.6; 95% CI 0.4 to 0.9).</p>
<p id="P11">Although the risk of serious adverse events was consistently higher if women received radiotherapy rather than no further treatment, these increased risks were not statistically significant, probably because the rate of adverse events was low.</p>
</sec>
<sec id="S7"><title>Authors’ conclusions</title>
<p id="P12">We found evidence, of moderate quality, that radiation decreases the risk of disease progression compared with no further treatment, but little evidence that it might improve overall survival, in stage IB cervical cancer. The evidence on serious adverse events was equivocal.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100909747</journal-id>
<journal-id journal-id-type="pubmed-jr-id">21711</journal-id>
<journal-id journal-id-type="nlm-ta">Cochrane Database Syst Rev</journal-id>
<journal-id journal-id-type="iso-abbrev">Cochrane Database Syst Rev</journal-id>
<journal-title-group><journal-title>The Cochrane database of systematic reviews</journal-title>
</journal-title-group>
<issn pub-type="epub">1469-493X</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">22592722</article-id>
<article-id pub-id-type="pmc">4171000</article-id>
<article-id pub-id-type="doi">10.1002/14651858.CD007583.pub3</article-id>
<article-id pub-id-type="manuscript">EMS58087</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Radiotherapy and chemoradiation after surgery for early cervical cancer</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Rogers</surname>
<given-names>Linda</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Siu</surname>
<given-names>Shing Shun N</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Luesley</surname>
<given-names>David</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bryant</surname>
<given-names>Andrew</given-names>
</name>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dickinson</surname>
<given-names>Heather O</given-names>
</name>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Department of Obstetrics and Gynaecology, H Floor Old Main Building, Observatory, Cape Town, South Africa</aff>
<aff id="A2"><label>2</label>
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Shatin, China</aff>
<aff id="A3"><label>3</label>
City Hospital & Birmingham Treatment Centre, Birmingham, UK</aff>
<aff id="A4"><label>4</label>
Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK</aff>
<author-notes><corresp id="CR1">Contact address: Linda Rogers, Department of Obstetrics and Gynaecology, H Floor Old Main Building, Groote Schuur Hospital, Anzio Rd, Observatory, Cape Town, 7925, South Africa. <email>linda.rogers@uct.ac.za</email>
</corresp>
<fn id="FN1"><p id="P1"><bold>CONTRIBUTIONS OF AUTHORS</bold>
LR, DL and SS drafted the clinical sections of the protocol; HD and AB drafted the methodological sections of the protocol. All authors agreed the final version of the review.</p>
</fn>
<fn id="FN2"><p id="P2"><bold>Editorial group:</bold>
Cochrane Gynaecological Cancer Group.</p>
<p id="P3"><bold>Publication status and date:</bold>
Edited (no change to conclusions), published in Issue 2, 2014.</p>
<p id="P4"><bold>Review content assessed as up-to-date:</bold>
30 March 2012.</p>
</fn>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>25</day>
<month>7</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub"><day>16</day>
<month>5</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="collection"><year>2012</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>22</day>
<month>9</month>
<year>2014</year>
</pub-date>
<volume>5</volume>
<fpage>CD007583</fpage>
<lpage>CD007583</lpage>
<pmc-comment>elocation-id from pubmed: 10.1002/14651858.CD007583.pub3</pmc-comment>
<permissions><copyright-statement>Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd</copyright-statement>
<copyright-year>2014</copyright-year>
</permissions>
<abstract><sec id="S1"><title>Background</title>
<p id="P5">This is an updated version of the original Cochrane review first published in Issue 4, 2009. There is an ongoing debate about the indications for, and value of, adjuvant pelvic radiotherapy after radical surgery in women with early cervical cancer. Certain combinations of pathological risk factors are thought to represent sufficient risk for recurrence, that they justify the use of postoperative pelvic radiotherapy, though this has never been shown to improve overall survival, and use of more than one type of treatment (surgery and radiotherapy) increases the risks of side effects and complications.</p>
</sec>
<sec id="S2"><title>Objectives</title>
<p id="P6">To evaluate the effectiveness and safety of adjuvant therapies (radiotherapy, chemotherapy followed by radiotherapy, chemoradiation) after radical hysterectomy for early-stage cervical cancer (FIGO stages IB1, IB2 or IIA).</p>
</sec>
<sec id="S3"><title>Search methods</title>
<p id="P7">For the original review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 4, 2008. The Cochrane Gynaecological Cancer Group Trials Register, MEDLINE (January 1950 to November 2008), EMBASE (1950 to November 2008). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. For this update, we extended the database searches to September 2011 and searched the MetaRegister for ongoing trials.</p>
</sec>
<sec id="S4"><title>Selection criteria</title>
<p id="P8">Randomised controlled trials (RCTs) that compared adjuvant therapies (radiotherapy, chemotherapy followed by radiotherapy, or chemoradiation) with no radiotherapy or chemoradiation, in women with a confirmed histological diagnosis of early cervical cancer who had undergone radical hysterectomy and dissection of the pelvic lymph nodes.</p>
</sec>
<sec id="S5"><title>Data collection and analysis</title>
<p id="P9">Two review authors independently abstracted data and assessed risk of bias. Information on grade 3 and 4 adverse events was collected from the trials. Results were pooled using random-effects meta-analyses.</p>
</sec>
<sec id="S6"><title>Main results</title>
<p id="P10">Two RCTs, which compared adjuvant radiotherapy with no adjuvant radiotherapy, met the inclusion criteria; they randomised and assessed 397 women with stage IB cervical cancer. Meta-analysis of these two RCTs indicated no significant difference in survival at 5 years between women who received radiation and those who received no further treatment (risk ratio (RR) = 0.8; 95% confidence interval (CI) 0.3 to 2.4). However, women who received radiation had a significantly lower risk of disease progression at 5 years (RR 0.6; 95% CI 0.4 to 0.9).</p>
<p id="P11">Although the risk of serious adverse events was consistently higher if women received radiotherapy rather than no further treatment, these increased risks were not statistically significant, probably because the rate of adverse events was low.</p>
</sec>
<sec id="S7"><title>Authors’ conclusions</title>
<p id="P12">We found evidence, of moderate quality, that radiation decreases the risk of disease progression compared with no further treatment, but little evidence that it might improve overall survival, in stage IB cervical cancer. The evidence on serious adverse events was equivocal.</p>
</sec>
</abstract>
<kwd-group kwd-group-type="Medical Subject Headings"><title>Medical Subject Headings (MeSH)</title>
<kwd>Chemoradiotherapy, Adjuvant</kwd>
<kwd>Hysterectomy</kwd>
<kwd>Neoplasm Recurrence, Local</kwd>
<kwd>Neoplasm Staging</kwd>
<kwd>Radiotherapy, Adjuvant [adverse effects; methods; mortality]</kwd>
<kwd>Randomized Controlled Trials as Topic</kwd>
<kwd>Uterine Cervical Neoplasms [mortality; pathology; *radiotherapy; surgery]</kwd>
</kwd-group>
<kwd-group kwd-group-type="MeSH check words"><title>MeSH check words</title>
<kwd>Female</kwd>
<kwd>Humans</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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