Concurrent weekly single cisplatin vs triweekly cisplatin alone with radiotherapy for treatment of locally advanced cervical cancer: a meta-analysis

Abstract

Background

Radiotherapy (RT) concurrent with cisplatin (CDDP) is the standard regimen used for treatment of locally advanced cervical carcinoma. In this meta-analysis, we compared the weekly and triweekly single CDDP concomitant chemoradiation regimens for treatment of cervical cancer with respect to compliance, recurrence, survival, and acute adverse effects.

Materials and methods

A systematic search for relevant studies was conducted in PubMed, Cochrane Library, EMBASE, and Medline databases. Fixed- or random-effects model was used for pooled analysis. The end points were overall survival, recurrence, compliance, and acute adverse effect reported as odds ratios (ORs) and 95% CIs.

Results

Six randomized trials and two retrospective studies qualified the inclusion criteria. The regimen of triweekly CDDP alone concurrent with RT showed better compliance (OR, 0.49; 95% CI, 0.29–0.83; P=0.009). No significant difference was observed between the 2 arms with respect to recurrence, survival, and acute adverse effects (all P>0.05). However, triweekly CDDP regimen was associated with significantly lower incidence of local recurrence (OR, 1.83; 95% CI: 1.12–3.01; P=0.02), while weekly CDDP regimen was associated with a lower risk of leucopenia (OR, 0.30; 95% CI: 0.10–0.92; P=0.03).

Conclusion

Triweekly single platinum chemotherapy plus concurrent RT was superior to weekly CDDP regimen with respect to local recurrence and treatment compliance in patients with locally advanced cervical carcinoma.

Keywords:

• locally advanced cervical carcinoma
• chemoradiotherapy
• cisplatin
• weekly
• triweekly

Supplementary materials

1. Compliance

   Metabias qwevent qwtotal q3wevent q3wtotal, Harbord graph.

   Note: data input format tcases tnoncases ccases cnoncases assumed. Odds ratios assumed as effect estimate of interest (Table S1).

2. Five-year OS

   Metabias qwevent qwtotal q3wevent q3wtotal, Harbord graph.

   Note: data input format tcases tnoncases ccases cnoncases assumed. Odds ratios assumed as effect estimate of interest (Table S2).

3. Five-year recurrence

   Metabias qwevent qwtotal q3wevent q3wtotal, Harbord graph.

   Note: data input format tcases tnoncases ccases cnoncases assumed. Odds ratios assumed as effect estimate of interest (Table S3).

4. Subgroup-local

   Metabias qwevent qwtotal q3wevent q3wtotal, Harbord graph.

   Note: data input format tcases tnoncases ccases cnoncases assumed. Odds ratios assumed as effect estimate of interest (Table S4).

5. Subgroup-distance

   Metabias qwevent qwtotal q3wevent q3wtotal, Harbord graph.

   Note: data input format tcases tnoncases ccases cnoncases assumed. Odds ratios assumed as effect estimate of interest (Table S5).

6. Vomiting

   Metabias qwevent qwtotal q3wevent q3wtotal, Harbord graph.

   Note: data input format tcases tnoncases ccases cnoncases assumed. Odds ratios assumed as effect estimate of interest (Table S6).

Table S1 Harbord’s modified test for small-study effects

Table S2 Harbord’s modified test for small-study effects

Table S3 Harbord’s modified test for small-study effects

Table S4 Harbord’s modified test for small-study effects

Table S5 Harbord’s modified test for small-study effects

Table S6 Harbord’s modified test for small-study effects

Acknowledgments

This study was sponsored partly by Research and Development Key Program of Jiangsu Province (Grant BE2015645) and Grant Z201413 from Scientific Research Project of Health Department of Jiangsu Province and Suzhou Key Medical Center Program (Grant szzx201506).

Disclosure

The authors report no conflicts of interest in this work.