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The role of neoadjuvant chemotherapy in the management of locally advanced cervix cancer: a systematic review

机译：新辅助化疗在局部晚期宫颈癌治疗中的作用：系统评价

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Cervical cancer is the second most common cancer in women. Neoadjuvant chemotherapy for patients with locally advanced cervix cancer has comparable benefits to concurrent chemoradiotherapy (CCRT), but with fewer side effects. This systematic review aims to provide a comprehensive summary of the benefits of neoadjuvant chemotherapy for the management of locally advanced cervix cancer from stage IB2 (tumor 4.0 cm) to IIIB (tumor extending to the pelvic wall and/or hydronephrosis). Our primary objective was to assess benefits in terms of survival. The data source included the USA national library of medicine, Medline search, and the National Cancer Institute PDQ Clinical Protocols. Inclusion criteria for consideration in the current systematic review included studies published between January 1997 and December 2012. In terms of histology, they had to be focused on squamous cell carcinoma, adenosquamous carcinoma, and/or adenocarcinoma. Patients should be either chemotherapy na?ˉve or cervix cancer chemotherapy na?ˉve, and have a performance status a‰¤2. The search in the above-mentioned scientific websites led to identify 49 publications, 19 of which were excluded, as they did not meet the inclusion criteria of this systematic review. Therefore only 30 studies were deemed eligible. Data was collected from 1760 patients enrolled in the current systematic review study. The mean age was 45.2 years. The mean tumor size was 4.7 cm. The most commonly used chemotherapies were cisplatin doublets. Paclitaxel was the most commonly used chemotherapeutic agent in the doublets. The mean chemotherapy cycles were 2.7. After chemotherapy, patients underwent surgery after a mean time of 2.5 weeks. The standard operation was radical hysterectomy with pelvic lymphadenectomy. Chemotherapy achieved an objective response rate of 84%. The 5-year progression-free survival and overall survival were 61.9% and 72.8% respectively. The treatment protocol was associated with a mild early toxicity profile. Leucopenia and neutropenia were the most common side effects. Late toxicity was also generally mild and mainly associated with bladder dysfunction and vaginal dehiscence. The quality of the studies was assessed using the Newcastle-Ottawa quality assessment scale. Neoadjuvant chemotherapy achieved comparable survival results to CCRT, and was associated with less toxicity.
机译：宫颈癌是女性中第二大最常见的癌症。对于局部晚期宫颈癌患者，新辅助化疗与同期放化疗（CCRT）具有可比的益处，但副作用较少。本系统综述旨在提供新辅助化疗对从IB2期（肿瘤> 4.0 cm）至IIIB（肿瘤延伸至骨盆壁和/或肾积水）的局部晚期宫颈癌治疗的益处的全面总结。我们的主要目标是评估生存率。数据源包括美国国家医学图书馆，Medline搜索和美国国家癌症研究所PDQ临床方案。本系统评价中需要考虑的纳入标准包括1997年1月至2012年12月发表的研究。就组织学而言，它们必须集中于鳞状细胞癌，腺鳞癌和/或腺癌。患者应初次接受化疗或宫颈癌初次接受化疗，并且表现状态≥2。在上述科学网站上进行的搜索确定了49篇出版物，其中19篇被排除在外，因为它们不符合本系统评价的纳入标准。因此，只有30项研究被认为是合格的。数据收集自参加当前系统评价研究的1760名患者。平均年龄为45.2岁。平均肿瘤大小为4.7cm。最常用的化学疗法是顺铂二联体。紫杉醇是双联体中最常用的化学治疗剂。平均化疗周期为2.7。化疗后，患者平均需要2.5周的时间进行手术。标准手术是根治性子宫切除术和盆腔淋巴结切除术。化学疗法的客观缓解率为84％。 5年无进展生存期和总生存期分别为61.9％和72.8％。该治疗方案与轻度早期毒性有关。白细胞减少和中性粒细胞减少是最常见的副作用。后期毒性一般也较轻，主要与膀胱功能障碍和阴道裂开有关。研究质量使用纽卡斯尔-渥太华质量评估量表进行评估。新辅助化疗的生存率与CCRT相当，且毒性较小。

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