Table 1 Characteristics of included studies

Inventions and Sample size

Intervention details

CCRT = 317 vs NACT+RS = 316

NACT+RS group: Paclitaxel combined with carboplatin was taken every three weeks for three cycles, and then a total hysterectomy was performed. CCRT group: standard radiotherapy combined with cisplatin once a week for 5 weeks.

CCRT+RS = 64 vs RT + RS = 73 vs RS = 122

CCRT + RS group: a total of 2 to 3 times, each dose of 1 week interval is 600–1000 cGy, and the total dose is 2000–300 cGy. The chemotherapy regimen is 5-FU 3.5–4.0 g/m2, continuous injection with a micropump for 96 h. DDP is 70 mg/m2, and intravenous chemotherapy is given for 1–2 days.

RT + RS group: radiotherapy after intracavitary loading before surgery.

RS group: radical resection of cervical cancer.

CCRT+RS = 44vs NACT+RS = 45

CCRT + RS group: 2 cycles of chemotherapy with an interval of 3–4 weeks, using bleomycin 20 U/m2 every day on Days 1–3. On the 4th day, 75 mg/m2 of cisplatin was infused intravenously. The radiation dose is 45 Gy.RS: Radical hysterectomy and pelvic lymph node dissection.

NACT + RS group: After the first two cycles of cisplatin and bleomycin treatment as above, the patient subsequently received two separate cisplatin treatments.RS: Radical hysterectomy and pelvic lymph node dissection.

CCRT+RS = 127 vs RS + RT = 116

CCRT + RS group: The radiation dose was 49.3 GY. The chemotherapy regimen included 4 cycles of 70 mg/m² cisplatin and 1000 mg/m² continuous fluorouracil. RS: radical hysterectomy and pelvic lymph node dissection.

RS + RT group: radical hysterectomy and pelvic lymph node dissection plus 49.3 GY radiotherapy.

NACT+RS = 210 vs RT = 199

NACT + RS group: cisplatin-based, followed by type III-V radical hysterectomy plus systemic pelvic lymphadenectomy. RT group: external beam radiation therapy (45 to 50 Gy), followed by brachytherapy (20 to 30 Gy).

NACT+RS = 68 vs RT = 52

NACT+RS group included either cisplatin 50 mg/m2 and vincristine 1 mg/m2 for 1 day and bleomycin 25 mg/m2 for 3 days for three cycles followed by radical hysterectomy.

RT group received primary pelvic radiotherapy only.

NACT+RS = 60 vs RS = 60

NACT + RS group: TP regimen: Cisplatin (70–80 mg/m2) plus paclitaxel (150–175 mg/m2), TC regimen: carboplatin (AUC = 5) + paclitaxel (150–175)) (mg / m²) and TN program: nedaplatin (70–80 mg/m²) + paclitaxel (150–175 mg/m²). 1–3 cycles of treatment every 3 weeks. Then, perform total hysterectomy and pelvic lymph node dissection.

RS group: radical hysterectomy and pelvic lymph node dissection were performed.

NACT+RS = 72 vs RS = 70

NACT + RS group: cisplatin 100 mg/m2 was given intravenously on day 1, mitomycin C 4 mg/m2 and 5-fluorouracil 24 mg/m2 were given from day 1 to day 5. There are two cycles of treatment with an interval of 14 days. After one week of treatment, the patient underwent type III radical hysterectomy and pelvic lymphadenectomy.

RS group: The patients directly underwent radical surgery.

NACT+RS = 32 vs RS = 32

NACT + RS group: 200 mg/m2 paclitaxel combined with 50 mg/m2 cisplatin treatment for 2 cycles. Three weeks after the chemotherapy, a radical resection of cervical cancer was performed.

RS group: patients only received radical surgery for cervical cancer.

NACT+RS = 64 vs RS = 67

NACT + RS group: BOMP regimen (Bleomycin 7 mg/m2 on day 1 to 5, vincristine 0.7 mg/m2 on day 5, Mitomycin 7 mg/m2 on day 5, cisplatin 14 mg/m2 from1 to 5 days, 2 to 4 cycles every 3 weeks) plus type III or type IV radical hysterectomy.

RS group: type III or type IV radical hysterectomy alone.

RS = 172 vs RT = 171

RT group: The median total radiation dose at point A was 76 Gy (range 70–90 Gy).

RS group: radical hysterectomy plus pelvic lymphadenectomy extended to level 2.

RT + RS = 38 vs RS = 40

RT + RS group: preoperative intracavitary brachytherapy with a dose of 2000–3000 cGy 192Ir. After 10–14 days, a radical hysterectomy combined with pelvic lymph node dissection was performed.

RS group: The patients directly received radical surgery.

RS + RT = 62 vs RT = 56

RT group: The radiation dose was 1000 cGy for the whole pelvis, and parametria was used for additional 4000 cGy;

RT + RS group: 2000 cGy was used to irradiate the entire pelvis, and then radical hysterectomy and pelvic lymph node dissection were performed 2 to 6 weeks later.

Conclusion

Cisplatin-based concomitant chemoradiation resulted in superior DFS compared with neoadjuvant chemotherapy followed by radical surgery in locally advanced cervical cancer.

The patients with locally advanced cervical cancer treated with preopera-tive concurrent chemoradiotherapy had more reduction in tumor size than those who did not receive such treatment. Pre-operative concurrent chemoradiotherapy can be considered safe, feasible, and worthy of further study.

CT + RT did not prove a superior adjuvant therapy for patients at high risk of recurrence after RH-PLND for early cervical cancer in this limited trial. Recurrence rates and patterns of recurrences (local, regional, or distant) were not influenced by the addition of RT.

The addition of concurrent cisplatin-based CT to RT significantly improves progression-free and overall survival for high-risk, early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix.

Although significant only for the stageIB2 to llB group, a survival benefit seems to be associ-ated with the NACT+RS compared with conventional RT.

NAC followed by radical hysterectomy and primary R/T showed similar efficacy for bulky stage IB or IIA cervical cancer.

Neoadjuvant chemotherapy can effectivelylower the levels of serum tumor markers and NLR, reducethe metastasis rate of cancer cells and the degree of cancer-related fatigue after operation,improve the quality of lifeand prolong the survival time.

The modified preoperative NAC is well tolerated and beneficial in reducing tumor size, eliminating pathological risk factors, and improving prognosis for responders. It also avoids the delay of effective treatment for non-NAC responders.

Neoadjuvant chemotherapy combined with cervical cancer radical surgery show goodclinical efficacy for treating cervical cancer, and because of the low incidence rate of complications,ithas clinical application value.

Neoadjuvant chemotherapy with BOMP regimen before RS did not improve overall survival, but reduced the numberof patients who received postoperative RT.

The results of the present study seem to suggest that there is no treatment of choice for early stage cervical carcinoma in terms of survival. Long term follow-up confirms that the best treatment for the individual patient should take into account clinical factors such as menopausal status, comorbidities, histological type, and tumor diameter.

Preoperativeintracavitary brachytherapy is an effective procedure for the treatment for stage l b. and ll a cervical cancerand can significantly improve the locoregional control rate.

The present study shows no significant difference in therapeutic results or morbidity for invasive carcinoma of theuterine cervix Stage IB or lIA treated with irradiation alone or combined with a radicalhysterectomy and lymphadenectomy.