Review supports use of chemoradiotherapy for cervical cancer

NEW YORK (Reuters Health) - All women with locally advanced cervical cancer can benefit from chemoradiotherapy -- and not only from platinum-based regimens - according to a new Cochrane report.

According to data presented in the January issue of the Cochrane Database of Systematic Reviews, using chemoradiotherapy instead of radiotherapy alone cut the relative risk of death at 5 years by 19% (p < 0.001) and yielded an absolute survival benefit of 6% (60% to 66%).

The authors note that after five supporting trials were published, the National Cancer Institute issued a clinical alert recommending chemoradiotherapy over radiotherapy alone. Two subsequent reviews generally confirmed the survival advantages with chemoradiotherapy, yet questions remained, such as which patients should receive this treatment, what regimen is optimal, and what are the relative toxicities.

To investigate, Dr. Claire L. Vale, from the MRC Clinical Trials Unit, London, and colleagues analyzed data from 15 trials identified through a search of MEDLINE, LILACS, and CANCERLIT updated until October 2009. The trials compared chemotherapy plus radical radiotherapy (with or without surgery) to radical radiotherapy alone in a total of 3452 women with locally advanced cervical cancer. Depending on the topic examined, however, not all trials were included in every analysis.

The findings showed that both platinum-based (HR, 0.84) and non-platinum-based (HR, 0.76) chemoradiotherapy improved survival. Radiotherapy or chemotherapy dose or scheduling did not significantly affect the magnitude of benefit.

Chemoradiotherapy was also associated with reduced local and distant recurrence, reduced disease progression, and with improved disease-free survival, the results indicate.

On subgroup analyses, age, histology, grade, and pelvic node involvement did not significantly affect the survival benefit of chemoradiotherapy. By contrast, there was a trend toward an impact of tumor stage, with the absolute survival benefit at 5 years ranging from 3% with stage 3 to 4a tumors to 10% with stage 1a to 2a tumors.

But "even if this trend had occurred by chance, applying the overall HR (0.81) to each of the stage subgroups gives an improvement in overall survival at 5 years for all stages, thus confirming chemoradiotherapy benefits women with all stages of cervical cancer, although the size of the benefit may vary," the authors say.

Relative to radiotherapy alone, chemoradiotherapy was associated with higher rates of acute hematological and gastrointestinal toxicity. The authors did not have enough data to examine late toxicity.

"We saw clear evidence that adding chemotherapy to radiotherapy improves survival, as well as disease-free survival," Dr. Vale said in a statement. "These are effective, affordable treatments that provide a benchmark for other potential treatment approaches."

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