PEARLS 260, May 2010, written by Brian R McAvoy 

Clinical question
How effective is chemoradiotherapy for patients with locally advanced cervical cancer?  

Bottom line
Compared with the same radiotherapy alone, chemoradiotherapy produced a 6% improvement in 5-year survival. A larger survival benefit was seen for the 2 further trials in which chemotherapy was administered after chemoradiotherapy. There was a significant survival benefit for both the group of trials that used platinum-based and non-platinum-based chemoradiotherapy, but no evidence of a difference in the size of the benefit by radiotherapy or chemotherapy dose or scheduling. Chemoradiotherapy also reduced local and distant recurrence and progression and improved disease-free survival. There was a suggestion of a difference in the size of the survival benefit with tumour stage, but not across other patient subgroups.  

Caveat
Currently there is insufficient evidence to suggest that any one treatment type, dose or schedule is better than any other. Acute haematological and gastrointestinal toxicity were increased with chemoradiotherapy, but data were too sparse for an analysis of late toxicity.

Context
Since a 1999 National Cancer Institute clinical alert was issued,¹ chemoradiotherapy has become widely used in treating women with cervical cancer. Two subsequent systematic reviews found interpretation of the benefits was complicated and some important clinical questions were unanswered. This review is a meta-analysis updating individual patient data from all available randomised controlled trials.  

Cochrane Systematic Review
Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis. Cochrane Reviews 2010, Issue 1. Article No. CD001758285. DOI: 10.1002/14651858.CD008285. This review contains 15 studies in 11 countries involving 3452 participants.  

Further references
1. National Cancer Institute. NCI Issues Clinical Announcement on Cervical Cancer: Chemotherapy plus Radiation Improves Survival.  http://www.nih.gov/