Efficacy and Safety of Irinotecan as Neoadjuvant Chemotherapy for Cervical Cancer: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 CHENDan-dan , YANGZhi-jun ,  LILi

Department of Gynecological Tumor, The Affiliated Tumor Hospital, Guangxi Medical University, Nanning 530021, China;

Corresponding?author：

LILi, Email: lili@gxmu.net.cn

Keywords：

Cervical cancer; Irinotecan; Systematic review; Meta-analysis; Randomized controlled trial; Clinical controlled trial

DOI：

10.7507/1672-2531.20150198

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Objective To systematically review the efficacy and safety of irinotecan as neoadjuvant chemotherapy (INAC) plus radical surgery (RS) for cervical cancer. Methods We searched databases including PubMed, EMbase, The Cochrane Library (Issue 10, 2014), CBM, CNKI, VIP and WanFang Data to collect clinical studies on INAC plus RS versus RS alone or other neoadjuvant chemotherapy drugs plus RS in the treatment of cervical cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 6 studies (4 RCTs and 2 CCTs) involving 596 patients were included. The results of meta-analysis showed that, compared with the RS alone group, the INAC group was superior in reducing operation time (MD=-16.17, 95%CI -21.88 to -10.46, P<0.000 01), intraoperative blood loss (MD=-39.56, 95%CI -51.96 to -27.17, P<0.000 01), increasing 3-years OS (OR=0.29, 95%CI 0.15 to 0.57, P<0.000 3), reducing incidence of positive parametrical involvement (OR=0.27, 95%CI 0.12 to 0.60, P=0.001) and incidence of lymphovascular space invasion (OR=0.24, 95%CI 0.09 to 0.61, P=0.003). However, there were no significant differences in the incidence of lymph node metastasis (OR=0.55, 95%CI 0.29 to 1.03, P=0.06) and positive surgical margin (OR=0.33, 95%CI 0.03 to 3.86, P=0.38) between the two groups. Compared with the paclitaxel plus RS group, there were no significant differences for the INAC group in the effective rate (OR=1.58, 95%CI 0.20 to 12.32, P=0.66) and the incidence of more than grade Ⅲ adverse events (OR=2.27, 95%CI 0.62 to 8.27, P=0.21). Conclusion INAC is effective and tolerable in the treatment of cervical cancer. Due to the limitation of quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： CHENDan-dan, YANGZhi-jun, LILi. Efficacy and Safety of Irinotecan as Neoadjuvant Chemotherapy for Cervical Cancer: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(10): 1196-1201. doi: 10.7507/1672-2531.20150198 Copy

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2.	Plotti F, Sansone M, Di Donato V, et al. Quality of life and sexual function after type C2/type Ⅲ radical hysterectomy for locally advanced cervical cancer:a prospective study. J Sex Med, 2011, 8(3):894-904.
3.	Lorusso D, Pietragalla A, Mainenti S, et al. Review role of topotecan in gynaecological cancers:current indications and perspectives. Crit Rev Oncol Hematol, 2010, 74(3):163-174.
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11.	Xiong Y, Liang LZ, Cao LP, et al. Clinical effects of irinotecan hydrochloride in combination with cisplatin as neoadjuvant chemotherapy in locally advanced cervical cancer. Gynecol Oncol, 2011, 123(1):99-104.
12.	歐瑜婷. 伊立替康聯合順鉑新輔助化療治療局部晚期宮頸癌的臨床研究. 南寧:廣西醫科大學, 2012.
13.	Bogani G, Cromi A, Serati M, et al. A prospective case-control study on the impact of neoadjuvant chemotherapy on surgery-related outcomes of laparoscopic radical hysterectomy. Anticancer Res, 2014, 34(10):5703-5708.
14.	Jiang L, Yang KH, Guan QL, et al. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer:an update meta-analysis based on randomized controlled trials. Surg Endosc, 2013, 27(7):2466-2480.
15.	杜文靜, 鄧云丹, 代強, 等. 腹腔鏡下根治性子宮切除術治療宮頸癌的Meta分析. 中國循證醫學雜志, 2014, 14(8):934-941.
16.	Rydzewska L, Tierney J, Vale CL, et al. Neoadjuvant chemotherapy plus surgery versus surgery for cervical cancer. Cochrane Database Syst Rev, 2012, 12:CD007406.
17.	Katsumata N, Yoshikawa H, Kobayashi H, et al. Phase Ⅲ randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, ⅡA2, and ⅡB cervical cancer:a Japan Clinical Oncology Group trial (JCOG 0102). Br J Cancer, 2013, 108(10):1957-1963.
18.	Yin M, Zhao F, Lou G, et al. The long-term efficacy of neoadjuvant chemotherapy followed by radical hysterectomy compared with radical surgery alone or concurrent chemoradiotherapy on locally advanced-stage cervical cancer. Int J Gynecol Cancer, 2011, 21(1):92-99.
19.	Chen H, Liang C, Zhang L, et al. Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to ⅡB) cervical cancer:randomized study. Gynecol Oncol, 2008, 110(3):308-315.
20.	Minig L, Colombo N, Zanagnolo V, et al. Platinum-based neoadjuvant chemotherapy followed by radical surgery for cervical carcinoma international federation of gynecology and obstetrics stage IB2-ⅡB. Int J Gynecol Cancer, 2013, 23(9):1647-1654.
21.	Moioli M, Papadia A, Mammoliti S, et al. Chemotherapy with cisplatin and paclitaxel in locally advanced cervical cancer:has this regimen still a role as neoadjuvant setting? Minerva Ginecol, 2012, 64(2):95-107.
22.	Shiozawa T, Tadokoro J, Fujiki T, et al. Risk factors for severe adverse effects and treatment-related deaths in Japanese patients treated with irinotecan-based chemotherapy:a postmarketing survey. Jpn J Clin Oncol, 2013, 43(5):483-491.
23.	李虎, 黃鶴, 劉繼紅. UGT1A1基因啟動子多態性與伊立替康化療毒性作用的關系. 中華婦產科雜志, 2011, 46(12):888-891.

1. Siegel R, Ma J, Zou Z, et al. Cancer statistics, 2014. CA Cancer J Clin, 2014, 64(1):9-29.
2. Plotti F, Sansone M, Di Donato V, et al. Quality of life and sexual function after type C2/type Ⅲ radical hysterectomy for locally advanced cervical cancer:a prospective study. J Sex Med, 2011, 8(3):894-904.
3. Lorusso D, Pietragalla A, Mainenti S, et al. Review role of topotecan in gynaecological cancers:current indications and perspectives. Crit Rev Oncol Hematol, 2010, 74(3):163-174.
4. Sugiyama T, Yakushiji M, Noda K, et al. Phase Ⅱ study of irinotecan and cisplatin as first-line chemotherapy in advanced or recurrent cervical cancer. Oncology, 2000, 58(1):31-37.
5. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at:http://www.cochrane-handbook.org.
6. Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies(minors):development and validation of a new instrument. ANZ J Surg, 2003, 73(9):712-716.
7. 張毅, 高霞, 周玉平, 等. 伊立替康聯合奈達鉑治療宮頸癌治療的臨床研究. 海南醫學院學報, 2013, 19(2):232-234.
8. 夏一丹, 羅軍. 伊立替康與紫杉醇聯合順鉑在宮頸癌新輔助化療中的比較. 四川醫學, 2013, 34(12):1805-1806.
9. 李琳, 邢輝, 周敏, 等. 宮頸癌新輔助化療119例臨床分析. 中國民族民間醫藥, 2009, 18(8):146.
10. 李琳, 周敏, 成莉, 等. 局部晚期宮頸癌患者新輔助化療療效觀察. 臨床和實驗醫學雜志, 2014, 13(3):208-210.
11. Xiong Y, Liang LZ, Cao LP, et al. Clinical effects of irinotecan hydrochloride in combination with cisplatin as neoadjuvant chemotherapy in locally advanced cervical cancer. Gynecol Oncol, 2011, 123(1):99-104.
12. 歐瑜婷. 伊立替康聯合順鉑新輔助化療治療局部晚期宮頸癌的臨床研究. 南寧:廣西醫科大學, 2012.
13. Bogani G, Cromi A, Serati M, et al. A prospective case-control study on the impact of neoadjuvant chemotherapy on surgery-related outcomes of laparoscopic radical hysterectomy. Anticancer Res, 2014, 34(10):5703-5708.
14. Jiang L, Yang KH, Guan QL, et al. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer:an update meta-analysis based on randomized controlled trials. Surg Endosc, 2013, 27(7):2466-2480.
15. 杜文靜, 鄧云丹, 代強, 等. 腹腔鏡下根治性子宮切除術治療宮頸癌的Meta分析. 中國循證醫學雜志, 2014, 14(8):934-941.
16. Rydzewska L, Tierney J, Vale CL, et al. Neoadjuvant chemotherapy plus surgery versus surgery for cervical cancer. Cochrane Database Syst Rev, 2012, 12:CD007406.
17. Katsumata N, Yoshikawa H, Kobayashi H, et al. Phase Ⅲ randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, ⅡA2, and ⅡB cervical cancer:a Japan Clinical Oncology Group trial (JCOG 0102). Br J Cancer, 2013, 108(10):1957-1963.
18. Yin M, Zhao F, Lou G, et al. The long-term efficacy of neoadjuvant chemotherapy followed by radical hysterectomy compared with radical surgery alone or concurrent chemoradiotherapy on locally advanced-stage cervical cancer. Int J Gynecol Cancer, 2011, 21(1):92-99.
19. Chen H, Liang C, Zhang L, et al. Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to ⅡB) cervical cancer:randomized study. Gynecol Oncol, 2008, 110(3):308-315.
20. Minig L, Colombo N, Zanagnolo V, et al. Platinum-based neoadjuvant chemotherapy followed by radical surgery for cervical carcinoma international federation of gynecology and obstetrics stage IB2-ⅡB. Int J Gynecol Cancer, 2013, 23(9):1647-1654.
21. Moioli M, Papadia A, Mammoliti S, et al. Chemotherapy with cisplatin and paclitaxel in locally advanced cervical cancer:has this regimen still a role as neoadjuvant setting? Minerva Ginecol, 2012, 64(2):95-107.
22. Shiozawa T, Tadokoro J, Fujiki T, et al. Risk factors for severe adverse effects and treatment-related deaths in Japanese patients treated with irinotecan-based chemotherapy:a postmarketing survey. Jpn J Clin Oncol, 2013, 43(5):483-491.
23. 李虎, 黃鶴, 劉繼紅. UGT1A1基因啟動子多態性與伊立替康化療毒性作用的關系. 中華婦產科雜志, 2011, 46(12):888-891.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Irinotecan as Neoadjuvant Chemotherapy for Cervical Cancer: A Meta-analysis

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