Adjuvant platinum-based chemotherapy for early stage cervical cancer
Evidence SummariesLevel of Evidence = D
Addition of cisplatin-based chemotherapy to radiotherapy might possibly increase survival and decrease disease progression in the adjuvant treatment of early stage cervical cancer with risk factors for recurrence, although the evidence is insufficient.
A Cochrane review 1 included 4 studies with a total of 401 patients with cervical cancer. Patients had stage IA2, IB1 or IIA cancer with risk factors for recurrence. Trials compared adjuvant radiotherapy with adjuvant radiotherapy combined with cisplatin-based chemotherapy after radical surgery. The median follow-up varied from 29 to 42 months. Two studies compared chemotherapy and radiotherapy with radiotherapy alone; adjuvant chemotherapy significantly reduced the risk of death (HR 0.56, 95% CI 0.36 to 0.87; 2 studies, n=243) and disease progression (HR 0.47, 95% CI 0.30 to 0.74; 2 studies, n=243), but increased the risk of grade 4 toxicities (RR 5.7, 95% CI 2.1 to 15). One study compared chemotherapy followed by radiotherapy with radiotherapy alone and found no significant difference between the groups (HR 1.34, 95% CI 0.24 to 7.66; n=71).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding, one trial lacking statistical power), by indirectness (short follow up time) and inconsistency (variability in results across studies).
1. Rosa DD, Medeiros LR, Edelweiss MI, Bozzetti MC, Pohlmann PR, Stein AT, Dickinson HO. Adjuvant platinum-based chemotherapy for early stage cervical cancer. Cochrane Database Syst Rev 2009 Jul 8;(3):CD005342 [Review content assessed as up-to-date: 8 September 2016]. [PMID:19588370]
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