Marcin Miszczyk , Tao Wu , Kasper Kuna , Magdalena Stankiewicz , Emilia Staniewska , Zuzanna Nowicka , Ziqin Chen , Loren K. Mell , Joachim Widder , Maximilian Schmidt , Rafał Tarnawski , Paweł Rajwa , Shahrokh F. Shariat , Pixiao Zhou
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Risk of bias (RoB) was assessed using Cochrane Collaboration’s RoB tool. Random-effects models were used for the <em>meta</em>-analysis.</p></div><div><h3>Results</h3><p>A total of 17 trials encompassing 1297 patients were included. The majority were single-centre trials (n = 1268) performed in China (n = 1128). Most trials used CT-based anatomical BMS (n = 1076). There was a comparable representation of trials in the definitive (n = 655) and postoperative (n = 582) settings, and the remaining trials included both.</p><p>Twelve studies reported data on G ≥ 3 (n = 782) and G ≥ 2 (n = 754) haematologic adverse events. Both G ≥ 3 (OR 0.39; 95 % CI 0.28–0.55; p < 0.001) and G ≥ 2 (OR 0.29; 95 % CI 0.18–0.46; p < 0.001) toxicity were significantly lowered, favouring BMS. Seven studies (n = 635) reported data on chemotherapy interruptions, defined as receiving less than five cycles of cisplatin, which were significantly less frequent in patients treated with BMS (OR 0.44; 95 % CI 0.24–0.81; p = 0.016). There was no evidence of increased gastrointestinal or genitourinary toxicity.</p><p>There were no signs of significant heterogeneity. Four studies were assessed as high RoB; sensitivity analyses excluding these provided comparable results for main outcomes. The main limitations include heterogeneity in BMS methodology between studies, low representation of populations most affected by cervical cancer, and insufficient data to assess survival outcomes.</p></div><div><h3>Conclusions</h3><p>The addition of BMS to definitive CRT in cervical cancer patients decreases hematologic toxicity and the frequency of interruptions in concurrent chemotherapy. 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The majority were single-centre trials (n = 1268) performed in China (n = 1128). Most trials used CT-based anatomical BMS (n = 1076). There was a comparable representation of trials in the definitive (n = 655) and postoperative (n = 582) settings, and the remaining trials included both.</p><p>Twelve studies reported data on G ≥ 3 (n = 782) and G ≥ 2 (n = 754) haematologic adverse events. Both G ≥ 3 (OR 0.39; 95 % CI 0.28–0.55; p < 0.001) and G ≥ 2 (OR 0.29; 95 % CI 0.18–0.46; p < 0.001) toxicity were significantly lowered, favouring BMS. Seven studies (n = 635) reported data on chemotherapy interruptions, defined as receiving less than five cycles of cisplatin, which were significantly less frequent in patients treated with BMS (OR 0.44; 95 % CI 0.24–0.81; p = 0.016). There was no evidence of increased gastrointestinal or genitourinary toxicity.</p><p>There were no signs of significant heterogeneity. 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引用次数: 0
摘要
背景同期化放疗（CRT）是局部晚期宫颈癌的标准治疗方法。方法我们检索了MEDLINE、Embase、Web of Science Core Collection、Google Scholar、Sinomed、CNKI和万方数据库中2010/01/01至2023/10/31期间发表的英文或中文文章。全文纳入了对宫颈癌患者进行明确或术后 CRT 治疗的 BMS 前瞻性随机试验的稿件。使用 Cochrane 协作组织的 RoB 工具评估偏倚风险（RoB）。结果 共纳入了 17 项试验，涵盖 1297 名患者。其中大部分是在中国进行的单中心试验（n = 1268）（n = 1128）。大多数试验采用基于 CT 的解剖 BMS（n = 1076）。12项研究报告了G≥3（782例）和G≥2（754例）血液学不良事件的数据。G ≥ 3（OR 0.39；95 % CI 0.28-0.55；p <；0.001）和 G ≥ 2（OR 0.29；95 % CI 0.18-0.46；p <；0.001）毒性均显著降低，有利于 BMS。七项研究（n = 635）报告了化疗中断的数据，化疗中断的定义是接受顺铂治疗少于五个周期，在接受 BMS 治疗的患者中，化疗中断的频率明显降低（OR 0.44；95 % CI 0.24-0.81；p = 0.016）。没有证据表明胃肠道或泌尿生殖系统毒性增加。有四项研究被评估为高RoB；敏感性分析排除了这些研究，主要结果具有可比性。结论在宫颈癌患者的最终CRT中加入BMS可降低血液学毒性和同时化疗中断的频率。结论在宫颈癌患者的最终 CRT 中加入 BMS 可降低血液毒性和同期化疗的中断频率，但目前尚无足够数据验证其对生存和疾病控制的影响。
Clinical outcomes of pelvic bone marrow sparing radiotherapy for cervical cancer: A systematic review and meta-analysis of randomised controlled trials
Background
Concurrent chemoradiotherapy (CRT) is the standard treatment for locally advanced cervical cancer. We investigated how additional bone marrow sparing (BMS) affects the clinical outcomes.
Methods
We queried MEDLINE, Embase, Web of Science Core Collection, Google Scholar, Sinomed, CNKI, and Wanfang databases for articles published in English or Chinese between 2010/01/01 and 2023/10/31. Full-text manuscripts of prospective, randomised trials on BMS in cervical cancer patients treated with definitive or postoperative CRT were included. Risk of bias (RoB) was assessed using Cochrane Collaboration’s RoB tool. Random-effects models were used for the meta-analysis.
Results
A total of 17 trials encompassing 1297 patients were included. The majority were single-centre trials (n = 1268) performed in China (n = 1128). Most trials used CT-based anatomical BMS (n = 1076). There was a comparable representation of trials in the definitive (n = 655) and postoperative (n = 582) settings, and the remaining trials included both.
Twelve studies reported data on G ≥ 3 (n = 782) and G ≥ 2 (n = 754) haematologic adverse events. Both G ≥ 3 (OR 0.39; 95 % CI 0.28–0.55; p < 0.001) and G ≥ 2 (OR 0.29; 95 % CI 0.18–0.46; p < 0.001) toxicity were significantly lowered, favouring BMS. Seven studies (n = 635) reported data on chemotherapy interruptions, defined as receiving less than five cycles of cisplatin, which were significantly less frequent in patients treated with BMS (OR 0.44; 95 % CI 0.24–0.81; p = 0.016). There was no evidence of increased gastrointestinal or genitourinary toxicity.
There were no signs of significant heterogeneity. Four studies were assessed as high RoB; sensitivity analyses excluding these provided comparable results for main outcomes. The main limitations include heterogeneity in BMS methodology between studies, low representation of populations most affected by cervical cancer, and insufficient data to assess survival outcomes.
Conclusions
The addition of BMS to definitive CRT in cervical cancer patients decreases hematologic toxicity and the frequency of interruptions in concurrent chemotherapy. However, data are insufficient to verify the impact on survival and disease control.
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