Adjuvant radiotherapy for intermediate-risk early-stage cervical cancer post radical hysterectomy: a systematic review and meta-analysis

Abstract

The risk of recurrence of early-stage cervical cancer (CC) is asso- ciated with prognostic factors such as tumor size, lymphovascular space invasion (LVSI), and deep stromal invasion (DSI). However, the adjuvant pelvic radiotherapy (RT) fol- lowing surgery to reduce the risk of recurrence in “intermediate risk” remains controver- sial. This study aims to evaluate the role of adjuvant RT in the recurrence and identify prognostic factors. Methods: A systematic search of PubMed, Embase, and Cochrane databases was performed to identify studies comparing adjuvant RT versus no adjuvant treatment in early-stage CC patients with intermediate-risk factors defined by GOG-92 criteria. Outcomes were recurrence, local recurrence, death, 5-year overall survival (5y-OS), and 5-year disease-free survival (5y-DFS). Tumor size ≥ 4 cm, LVSI, and DSI were also evaluated as prognostic factors for recurrence. Statistical analysis was performed using Review Manager 7.2.0. Heterogeneity was assessed with I2 statistics. Results: A total of 1504 patients from nine studies were included; only one study was a randomized con- trolled trial, while the others were retrospective cohorts. Adjuvant RT was used to treat 781 patients (52%). Median follow-up ranged from 48 to 120 months. Recurrence (OR 0.75; 95% CI 0.38–1.46; p = 0.39), local recurrence (OR 0.73; 95% CI 0.44–1.20; p = 0.22), death (OR 0.97; 95% CI 0.52–1.80; p = 0.91), 5y-OS (OR 1.22; 95% CI 0.36–4.18; p = 0.75), and 5y-DFS (OR 0.78; 95% CI 0.42–1.43 p = 0.42) revealed no statistically significant differences between adjuvant RT and observation groups. TS ≥ 4 cm was an independent prognostic risk factor for recurrence (HR 1.83; 95% CI 1.12–2.97; p = 0.02). Conclusions: Our findings suggest that adjuvant RT does not reduce recurrence risk in early-stage cervical cancer. Consider TS ≥ 4 cm as a significant prognostic factor for recurrence. Adjuvant RT in intermediate-risk patients should be considered with caution due the lack of significant improvement in recurrence until the CERVANTES and GOG-0263 trial results become available.