Chemo Radiotherapy For Cervical Cancer Methodological

Chemoradiotherapy for
cervical cancer: a
Cochrane review using
individual patient data
Methodological
www.cochranejournalclub.com
Clinical questions
• What is the effect of
chemoradiotherapy compared to
radiotherapy for women with limited
or locally advanced cervical cancer?
• How does the effect differ for
different types of women and for
different types forofCervical
Source: Chemoradiotherapy treatment?
Cancer Meta-analysis
Collaboration.
Reducing uncertainties about the effects of chemoradiotherapy for cervical cance
. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.:
CD008285. DOI: 10.1002/14651858.CD008285.pub2.
Context
• Cervical cancer is the second most common cancer among
women and the main cancer affecting women in sub-Saharan
Africa, central America and south-central Asia.
• Chemoradiotherapy involves the use of chemotherapy at the
same time as radiotherapy.
• In 1999, a clinical alert from the National Cancer Institute in
the United States said that chemoradiotherapy should be
considered for women with cervical cancer.
• Subsequent systematic reviews found that interpretation of the
benefits was complicated and some important clinical
questions were unanswered.
Methods
• A Cochrane intervention review, conducted by a
collaborative group of researchers responsible for the
randomised trials.
• Information on published and unpublished trials was
sought from bibliographic databases, trial registers,
conference proceedings and the participating
investigators.
• Individual patient data were collected from each trial, to
allow time-to-event analyses and investigation of
differences in the effect of chemoradiotherapy by trial
and patient characteristics.
• Updated follow-up data were sought, to look at these
outcomes in the long-term.
Some benefits of individual
patient data
• Time-to-event analyses
• Subgroup analyses
• Flexible analysis of outcomes
• Detailed data checking
• Assess quality of randomisation and follow
up
• Standard analysis
• Link events and participants
• Link participants who are not independent
• Update follow up information
Individual patient data
requested
Baseline characteristics Outcomes
• Patient ID • Tumour response
• Centre ID • Local recurrence status
• Patient date of birth or age • Date of local recurrence
• Tumour histology • Distant metastases status
• Tumour stage • Date of distant metastases
• Tumour grade • Survival status
• Lymph node involvement • Date of death / last follow-up
• Patient performance status • Acute toxicity
• Allocated treatment • Late toxicity
• Date of randomisation
Other
Treatment characteristics • Cause of death
• Surgery • Excluded from analysis
• External beam radiotherapy • Reason for exclusion
• Brachytherapy
Analyses
• Intention-to-treat analysis
• Times to event (death, recurrence etc)
used to calculate hazard ratios (HRs)
• Fixed-effect model
• Logrank test stratified by trial
• Kaplan-Meier curves
• Absolute effect calculated from control-
group survival
• Trial group and patient subgroup analyses
Description of eligible
studies
• Individual patient data were available for 3452 women in 15
trials, including 118 women excluded from the researchers’
original analyses.
• Overall survival, disease-free survival, locoregional disease-free
survival and metastases-free survival were provided for all trials.
Median follow-up for living patients was 5.2 years.
• Data on age were provided for all trials. Histology and stage,
performance status and grade were available for most trials.
• Data were not available for ten eligible trials (1,113 patients):
data could not be located for six trials (814 patients) and contact
could not be made with the investigators of four trials (299
patients).
Results: Overall survival
• In the 13 trials that did not use additional, adjuvant
chemotherapy after chemoradiotherapy, the hazard ratio for
mortality was 0.81 (95% CI 0.71 to 0.91, p<0.001). The benefit
appeared larger when adjuvant chemotherapy was used.
• The 19% reduction in hazard ratio translates to an absolute
survival benefit of 6% at five years - an increase in the average
number of survivors from 60 to 66 per hundred.
• The effects were similar for platinum-based and non-platinum
based chemoradiotherapy.
• There was a suggestion of a difference in the size of the benefit
with tumour stage, but not across other patient subgroups.
Survival: 13 trials, 3104
1.0
participants
0.9
0.8
0.7 Chemoradiothera
0.6
Radiotherapy py
0.5
alone
0.4
vi vr uS
la
0.3
0.2
0.1
0.0
0 1 2 3 4 5 6 7 8 9 10
Time (years)
Survival: chemotherapy
regimen
Useful links
• Cochrane Journal Club discussion
points
• Cochrane review: Chemoradiotherapy fo
• Cochrane Handbook section on individua

data

Chemo Radiotherapy For Cervical Cancer Methodological

Uploaded by

Copyright:

Available Formats

Chemo Radiotherapy For Cervical Cancer Methodological

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chemo Radiotherapy For Cervical Cancer Methodological

Uploaded by

Copyright:

Available Formats

Chemoradiotherapy for

• Cochrane review: Chemoradiotherapy fo

• Cochrane Handbook section on individua

You might also like