Cervix Cochrane Metaanalysis on Chemoradiation 2010

This is a notification on an important publication

The article

The Cochrane Collaboration - or rather the Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration (CCCMAC) - have recently published a meta-analysis of individual patient data regarding the role of concurrent and adjuvant chemotherapy with radiation in uterine cervical cancer.

Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis.
Read the full text here:
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008285/frame.html
Pubmed abstract:
http://www.pubmed.gov/20091664

Summary of methods:

  • Uses individual patient data from 13 RCTs comparing CTRT with RT alone
  • 2 more RCTs comparing adjuvant CT after CTRT vs. no further treatment
  • 3452 patients in total

Main results

  • Absolute survival benefit of 6% at 5-years, HR 0.81 (i.e. 19% relative benefit), p<0.001 with concomitant CT.
  • Absolute benefit in DFS of 8% at 5 years, HR 0.79, p<0.001
  • Absolute benefit in Locoregional control of 9% at 5 years, HR0.76, p<0.001
  • Absolute benefit in Metastasis-free survival of 6% at 5 years, HR 0.81, p<0.001
  • Survival benefit also seen in the setting of adjuvant chemotherapy.
  • Improvements seen in both platinum and non platinum based regimens.

Of interest

  • 30-40% of patients in control and experimental arms were in stage 3+
  • The magnitude of benefit diminished with increasing stage - 10% for 1-2a, 7% for 2b and 3% for 3-4a
  • The forest plot for stages 3-4a actually shows that the benefit is non-significant although in the discussion they say that by applying the overall HR of 0.81 to all stages subgroups the difference is small but statistically significa in all groups (I don't understand this fully).

What does this mean for practice?

There is no doubt that chemo helps - but for the predominantly stage 3+ patient population in India - what does this mean for practice?

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