Cervical cancer: Neoadjuvant chemotherapy, systematic review and IPD meta-analysis
Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data
Does giving chemotherapy before radiotherapy or surgery help women with cervical cancer?
What was this study about?
Cervical cancer is the second most common type of cancer in women worldwide. Women of all ages can get it, but it is more common in women of 30 to 40 years old. When the tumour is very small, doctors can remove it by taking out the cervix, womb and fallopian tubes in an operation called a simple hysterectomy. If the tumour is bigger, or has spread to tissues around the cervix (locally advanced cervical cancer), women might either have a bigger and more complicated operation called a radical hysterectomy to make sure that all of the cancer is removed, or they might have radiotherapy (treatment with x-rays).
We did a systematic review and a meta analysis of individual participant data looking whether it is helpful to give chemotherapy (drug treatment) before radiotherapy or surgery - this is sometimes called neo-adjuvant treatment. This brought together information from all patients who took part in similar randomised controlled trials. Some of these trials compared what happened to women who had chemotherapy before radiotherapy with those who just had radiotherapy. Other trials compared what happened to women who had chemotherapy before surgery with those who had radiotherapy.
What difference did this study make?
This study showed that giving chemotherapy over a longer period of time or less intensively before radiotherapy might be harmful. After five years, 35 out of 100 women who received chemotherapy before radiotherapy were alive compared to 45 out of 100 women who just had radiotherapy.
It also showed that intensive chemotherapy over a short period of time before radiotherapy might help women with cervical cancer live longer than those who just had radiotherapy. However, these results were less certain.
The study also showed that giving chemotherapy before surgery could help women live longer than those who had radiotherapy. However, because of differences between the trials, these results were also less certain.
The researchers recommended that more randomised controlled trials should be carried out to test whether giving chemotherapy before radiotherapy or surgery is better than giving chemotherapy alongside radiotherapy.
Neoadjuvant Chemotherapy for Cervix Cancer Meta-analysis (NACCCMA) Collaboration. Neoadjuvant chemotherapy for locally advanced cervical cancer: A systematic review and meta-analysis of individual patient data from 21 randomised trials. European Journal of Cancer. 2003;39(17):2470-86
Type of study
Who funded the study?
The Medical Research Council.
When did it take place?
This study was published in 2003. The trials included were done between 1975 and 2000.
Where did it take place?
The study was done at the MRC Clinical Trials Unit. But it brought together the results of trials from all over the world.
Who was included?
Women with locally advanced cervical cancer who took part in randomised controlled trials looking at chemotherapy before radiotherapy or surgery. The study brought together 21 trials from all over the world. These trials involved nearly 3,000 women with cervical cancer.