The efficacy and safety of neoadjuvant therapy followed by radical surgery versus definite chemoradiotherapy in the treatment of I_B2-II_B cervical cancer: a meta-analysis

Objective: To systematically evaluate the efficacy and safety between neoadjuvant therapy followed by radical surgery and definite chemoradiotherapy in the treatment of I_B2-II_B cervical cancer. Methods: A computerized search was performed in PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang Data, CNKI and VIP to collect controlled clinical trials related to neoadjuvant therapy followed by radical surgery versus definite chemoradiotherapy in the treatment of I_B2-II_B cervical cancer. The meta-analysis of survival data and adverse events was performed by Review Manager 5.3 software. Results: Nine controlled clinical trials involving 3914 patients were included in this meta-analysis. There were no significant differences in overall survival (HR = 0.83, P = 0.31) and progression-free survival (HR = O.85, P = 0.57) between two groups. Compared with patients receiving definite chemoradiotherapy, those in the neoadjuvant therapy group had a significantly lower risk of irradiation enteritis (RR = 0.27, P = 0.03), whereas no significant difference was observed in the risk of irradiation cystitis (RR = 0.30, P = 0.34) and grade ≥ 3 neutropenia (RR = 0.77, P = 0.46) between two groups. Conclusion: In the treatment of locally advanced I_B2-II_B cervical cancer, two modalities show similar survival benefits. Although the neoadjuvant therapy group yields a lower incidence of irradiation enteritis, the incidence rates of irradiation cystitis and grade ≥ 3 neutropenia do not significantly differ between two groups. Neoadjuvant therapy followed by radical surgery is not superior to the standard therapeutic regime. (authors)