Efficacy and safety of adjuvant chemotherapy for locally advanced cervical carcinoma: an updated Systematic review and meta-analysis

This meta-analysis assessed the latest clinical efficacy and safety of adjuvant chemotherapy (ACT) after concurrent chemoradiotherapy (CCRT) compared to CCRT alone for locally advanced cervical cancer. Studies were pooled <i>via</i> random effects model. Overall survival (OS; risk of death from any cause) and progression-free survival (PFS; risk of disease progression) were primary endpoints. Secondary outcomes included disease-free survival (DFS; absence of recurrence), local failure rate, distant metastasis rate (DMR), and toxicities. A total of 22 studies (<i>n</i> = 7466) were included. CCRT + ACT was associated with significant improvement in OS, PFS, and DMR compared to CCRT alone. Subgroup analyses of RCTs, studies with >3 ACT cycles, and with a follow-up of 5 years indicated no statistical difference in OS and PFS between two groups, suggesting that the clinical advantage of ACT may be limited, particularly given emerging immunotherapies. Moreover, ACT was associated with a higher rate of hematologic and gastrointestinal toxicities.