Cervical cancer: Chemoradiotherapy, systematic review and IPD meta-analysis

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). Some women who have radiotherapy might also get chemotherapy (drug treatment) at the same time as radiotherapy. This is called chemoradiotherapy (or chemoradiation). They may also get this treatment after they have had a hysterectomy.

In 2001, we did a systematic review looking at chemoradiotherapy. This brought together information from the reports of similar trials. These trials compared what happened to women with cervical cancer who were given chemoradiotherapy with those who had only radiotherapy. We found that chemoradiotherapy helped women live longer and helped stop their cancer coming back, but also that more information was needed to answer some other questions.

Therefore, we did a new systematic review and meta-analysis of individual patient data. It brought together information from all patients who took part in similar trials. It also included all trials, not just the reported ones. This makes it more reliable. This study aimed to find out how much better chemoradiotherapy was at helping women to live longer and stopping the cancer from coming back (recurrence) or spreading. It also aimed to see:

If chemoradiotherapy helped all types of women with locally advanced cervical cancer

• Which chemotherapy drugs worked best
• What the short and long-term side effects of chemoradiotherapy are

What difference did this study make?

This study showed that women with cervical cancer who had chemoradiotherapy lived longer than women who had just radiotherapy. After 5 years, 66 out of every 100 women who received chemoradiotherapy were still alive compared with 60 out of every 100 who just had radiotherapy. They were also less likely to have the cancer come back or spread to other parts of the body.

This study showed that the different drugs that had been used in the trials (cisplatin or 5-fluourouracil or mitomycin-C) all helped women to live longer or stop the cancer from coming back or spreading. It also showed chemoradiotherapy helped all women, even those with bigger tumours or tumours that had spread more. Giving extra chemotherapy after chemoradiotherapy may also be better, but this needs more research.

There are more short-term side effects from chemoradiotherapy than from radiotherapy. There was not enough information to tell if there are more long-term side effects.

The study showed that chemoradiotherapy can help all types of women with locally advanced cervical cancer live longer. If women cannot be given platinum chemotherapy drugs such as cisplatin it may be possible give them non-platinum drugs.

Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. Journal of Clinical Oncology. 2008;26(35):5802-12

Type of study

Meta-analyses

Contact details

MRCCTU.meta-analysis@ucl.ac.uk

Who funded the study?

The Medical Research Council funded the study. The Department of Health National Coordinating Centre for Research Capacity Development (NCCRCD) funded a person to lead the project.