Objective To assess the efficacy and safety of laparoscopic staging and surgery for patients with cervical cancer. Methods We searched The Cochrane Library, MEDLINE, EMbase, CBM (from inception to 2009). Randomized controlled trials (RCTs) were identified according to the inclusion and exclusion criteria, and then the quality of included trials was accessed, and the data were extracted. Meta-analysis was performed by RevMan 5.0.2 software. Results Two RCTs involving 120 participants were included. The results of meta-analyses showed laparoscopic surgery, compared with open surgery, shortened postoperative ileus time (MD= –18.20, 95%CI –22.20 to –14.20, Plt;0.001), reduced the postoperative pain (MD= –1.30, 95%CI –1.86, to –0.74, Plt;0.001) and shortened the overall hospital stay (MD= –1.30, 95%CI –1.59 to –1.01, Plt;0.001). Currently, no evidence supported the superiority of laparoscopic surgery on duration of surgery, number of harvested lymph node and intraoperative blood loss over open surgery. Moreover, the laparoscopic surgery neither increased nor decreased the risk of postoperative complications. Conclusion The laparoscopic staging and surgery could shorten the recovery time of gastrointestinal function, shorten hospital stay, reduce pain in patients, but have no advantages in postoperative complications, operative time, number of lymph node biopsy, and intraoperative blood loss, compared with open surgery. However, the evidence is not b enough because of the low quality of the included studies. Thus, more high-quality RCTs are required in future.
Objective To assess the efficacy and safety of neoadjuvant intraarterial chemotherapy in the treatment of advanced cervical cancer. Methods We searched databases including PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBMdisc, conference articles, and Ongoing Controlled Trial for Random Controlled Trials and quasi-Random Controlled Trials up to October 2009. For homogeneous studies, we performed meta-analysis. Results Fifteen studies involving 1 331 participants with advanced cervical cancer were included. Twelve studies showed that the efficacy of the NIC group was 6.72 times than that of the traditional group. Several studies showed that the survival rate of the NIC group was better than that of the traditional group. Meanwhile, the adverse events of the NIC group were fewer than those of the traditional group. Conclusions The results of this system review show that, NIC which is more effective than conventional treatments with less adverse reactions provides a new adjunct for clinical treatment of advanced cervical cancer . However, due to the current clinical treatment for the disease is the coexistence of multiple chemotherapy program status, the higher quality and more focused clinical research which will compare NIC with a variety of conventional chemotherapy are needed in the further.
ObjectiveTo systematically review the effectiveness and safety of laparoscopic radical hysterectomy (LRH) for cervical cancer. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 10, 2013), CBM, CNKI, VIP, WanFang Data (from inception to October, 2013) through computer, and manually searched related journals. Randomized controlled trials (RCTs) on LRH versus abdominal radical hysterectomy (ARH) in the treatment of cervical cancer were identified according to the inclusion and exclusion criteria, data were extracted, and methodological quality of the included studies was accessed by two reviewer independently. Meta-analysis was then performed using RevMan 5.2 software. ResultsSeven RCTs involving 462 patients were finally included. The results of meta-analysis showed that: there were significant differences between LRH and ARH in the operation time, intraoperative bleeding, recovery time of gastrointestinal function, postoperative pain, postoperative hospital stay, and surgical site infection (MD=20.25, 95%CI 0.26 to 40.24, P=0.05; MD=-56.18, 95%CI-74.84 to-37.52, P < 0.000 01; SMD=-1.54, 95%CI-2.92 to-0.16, P=0.03; MD=-1.37, 95%CI-1.85 to-0.89, P < 0.000 01; MD=-2.32, 95%CI-3.57 to-1.06, P=0.000 3; RR=0.42, 95%CI 0.18 to 0.97, P=0.04). But there was no significant difference in the number of lymph node biopsy (MD=1.34, 95%CI-4.26 to 6.94, P=0.64) and some operative complications (lymphocyte: RR=1.19, 95%CI 0.54 to 2.63, P=0.66; DVT: RR=1.23, 95%CI 0.48 to 3.20, P=0.67; urinary retention: RR=0.85, 95%CI 0.41 to 1.75, P=0.66; cystotomy: RR=1.91, 95%CI 0.49 to 7.51, P=0.35). ConclusionCurrent evidence shows that although applying LRH costs longer time, and with high-level technology, its safety and short-term efficacy are superior to ARH. Due to the limited quantity and quality of the included studies, its long-term efficacy still needs to be further confirmed by conducting more high-quality, multi-centre RCTs with large sample size.
Objective To evaluate the radical chemoradiotherapy plus surgery for locally advanced cervical patients. Methods 102 cases of patients with locally advanced cervical cancer were randomly divided into a trial group and a control group. In the control group, patients received radical chemoradiotherapy only, with chemotherapy consisted of cisplatin 35-40 mg/m2, one times a week. In the trial group, patients received both treatment in the control group and extensive hysterectomy and pelvic lymph node dissection. Results Fifty-two patients were randomly enrolled into the trial group and 50 patients into the control group. The microscopic residual tumor (MRT) rate was 5.8% (3/52) and non-microscopic residual tumor (NMRT) rate was 82.7% (43/52) in the trial group. Progression-free survival time was 3-40 months with a median survival time of 23 months, and the 3-year progression-free survival rate was 73.1% in the trial group, and progression-free survival time was 5–41 months with a median survival time of 22 months, and the 3-year progression-free survival rate was 64.8% in the control group; while the difference was not statistically significant (χ2=0.092,P=0.761). Overall survival time was 6–40 months with median overall survival time of 23 months, and the 3-year overall survival rate was 82.7% in the trial group, and overall survival time was 5-41 months with a median survival time of 22.5 months, and the 3-year overall survival rate was 81.8%; while the difference was not statistically significant (χ2=0.338,P=0.561). Conclusion Concomitant chemoradiation followed by radical surgery could not significantly improve progression-free survival and overall survival in patients with locally advanced cervical cancer. The treatment regimen should be applied with caution and selectivity.
ObjectivesTo explore the efficacy of simultaneous chemoradiotherapy combined with surgery for locally advanced cervical patients and perform multivariable analysis.MethodsA total of 130 cases of patients with locally advanced cervical cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from June 2012 to December 2016 were randomly divided into case group and control group. The patients in the control group were treated with platinum-based radical concurrent chemoradiation. In the case group, patients received both treatment in the control group with the addition of extensive hysterectomy and pelvic lymph node dissection. The short-term efficacy and survival outcomes of the two groups were compared.ResultsThe present study was the final report of this randomized controlled trial. 68 patients were randomly enrolled into the case group and 50 patients into control group. The non-microscopic residual tumor (non-MRT) rates were 83.8% (57/68) and microscopic residual tumor (MRT) rates were 2.9% (2/68) in the experimental group. There was no significant difference between two groups (χ2=0.008, P=0.928) in 3-year progression-free survival rate (65.6%vs. 59.6%) and 4-year progression-free survival rate (52.5% vs. 56.3%). And there was no significant difference between two groups (χ2=0.361, P=0.548) in 3-year overall survival rate (80.3%vs. 74.6%) and 4-year overall survival rate (77.6% vs. 64.9%). Multivariable analysis showed that only tumor size and parametrial invasion were significant prognostic factors of PFS (P<0.05). And only parametrial invasion was a potential prognostic indicator affecting OS (P=0.078).ConclusionParametrial invasion is an important prognostic factor. Radical concurrent chemoradiotherapy combined with surgical treatment of locally advanced cervical cancer has not significantly improved progression-free survival and overall survival. The treatment regimen should be applied with caution and selectivity.
ObjectivesTo compare the efficacy and safety of weekly nedaplatin compared with weekly cisplatin as postoperative concurrent chemoradiotherapy scheme for cervical cancer patients.MethodsThis trial was performed in the Department of Radiation Oncology in the Second Affiliated Hospital of Fujian Medical University from June 2016 to January 2017. A total of 200 patients with stage ⅠB1-ⅡB cervical cancer were randomly assigned to the nedaplatin group and the cisplatin group after signing informed content. The dose of nedaplatin or cisplatin ranged 35 to 40 mg/m2, once a week for 5 weeks. Intensity-modulated radiation therapy or three-dimensional conformal radiation therapy were used for patients. The progression-free survival, overall survival and adverse reactions were compared between two groups. Statistical analysis was performed by SPSS 24.0 software.ResultsA total of 105 patients were enrolled in the nedaplatin group, and 95 patients were in cisplatin group. The three-year progression-free survival rate was 80.5% vs. 79.5% in the nedaplatin group and the cisplatin group, respectively; and no statistical significant difference was found (χ2=0.198, P=0.656) between two groups. The 3-year overall survival rates were 72.5% and 69.9% for the nedaplatin group and the cisplatin group, respectively, and there was no significant difference between the two groups (χ2=0.261, P=0.609). The incidence of grade 3/4 nausea and vomiting in the nedaplatin group was 6.67%, which was significantly lower than that of 15.79% in the cisplatin group, and statistical significant difference was found (χ2=2.555, P=0.011); however, the incidence of grade 3/4 thrombocytopenia in the nedaplatin group was 9.52%, which was significantly higher than that in the cisplatin group (3.15%); and the difference was statistically significant (χ2=1.985, P=0.047). There was no difference in the incidence of adverse reactions such as anemia, neutropenia, and radiological proctitis in both groups.ConclusionsNedaplatin-based concurrent chemoradiotherapy has similar efficacy compared to cisplatin-based concurrent chemoradiotherapy, and it could significantly reduce the digestive tract reaction, which can be used as an alternative to cisplatin.