PDF(Pubmed)
Abstract：
UNASSIGNED: Concurrent chemoradiotherapy (CRT) is the standard treatment for locally advanced cervical cancer. We investigated how additional bone marrow sparing (BMS) affects the clinical outcomes.
UNASSIGNED: We queried MEDLINE, Embase, Web of Science Core Collection, Google Scholar, Sinomed, CNKI, and Wanfang databases for articles published in English or Chinese between 2010/01/01 and 2023/10/31. Full-text manuscripts of prospective, randomised trials on BMS in cervical cancer patients treated with definitive or postoperative CRT were included. Risk of bias (RoB) was assessed using Cochrane Collaboration\'s RoB tool. Random-effects models were used for the meta-analysis.
UNASSIGNED: A total of 17 trials encompassing 1297 patients were included. The majority were single-centre trials (n = 1268) performed in China (n = 1128). Most trials used CT-based anatomical BMS (n = 1076). There was a comparable representation of trials in the definitive (n = 655) and postoperative (n = 582) settings, and the remaining trials included both.Twelve studies reported data on G ≥ 3 (n = 782) and G ≥ 2 (n = 754) haematologic adverse events. Both G ≥ 3 (OR 0.39; 95 % CI 0.28-0.55; p < 0.001) and G ≥ 2 (OR 0.29; 95 % CI 0.18-0.46; p < 0.001) toxicity were significantly lowered, favouring BMS. Seven studies (n = 635) reported data on chemotherapy interruptions, defined as receiving less than five cycles of cisplatin, which were significantly less frequent in patients treated with BMS (OR 0.44; 95 % CI 0.24-0.81; p = 0.016). There was no evidence of increased gastrointestinal or genitourinary toxicity.There were no signs of significant heterogeneity. Four studies were assessed as high RoB; sensitivity analyses excluding these provided comparable results for main outcomes. The main limitations include heterogeneity in BMS methodology between studies, low representation of populations most affected by cervical cancer, and insufficient data to assess survival outcomes.
UNASSIGNED: The addition of BMS to definitive CRT in cervical cancer patients decreases hematologic toxicity and the frequency of interruptions in concurrent chemotherapy. However, data are insufficient to verify the impact on survival and disease control.
UNASSIGNED: We queried MEDLINE, Embase, Web of Science Core Collection, Google Scholar, Sinomed, CNKI, and Wanfang databases for articles published in English or Chinese between 2010/01/01 and 2023/10/31. Full-text manuscripts of prospective, randomised trials on BMS in cervical cancer patients treated with definitive or postoperative CRT were included. Risk of bias (RoB) was assessed using Cochrane Collaboration\'s RoB tool. Random-effects models were used for the meta-analysis.
UNASSIGNED: A total of 17 trials encompassing 1297 patients were included. The majority were single-centre trials (n = 1268) performed in China (n = 1128). Most trials used CT-based anatomical BMS (n = 1076). There was a comparable representation of trials in the definitive (n = 655) and postoperative (n = 582) settings, and the remaining trials included both.Twelve studies reported data on G ≥ 3 (n = 782) and G ≥ 2 (n = 754) haematologic adverse events. Both G ≥ 3 (OR 0.39; 95 % CI 0.28-0.55; p < 0.001) and G ≥ 2 (OR 0.29; 95 % CI 0.18-0.46; p < 0.001) toxicity were significantly lowered, favouring BMS. Seven studies (n = 635) reported data on chemotherapy interruptions, defined as receiving less than five cycles of cisplatin, which were significantly less frequent in patients treated with BMS (OR 0.44; 95 % CI 0.24-0.81; p = 0.016). There was no evidence of increased gastrointestinal or genitourinary toxicity.There were no signs of significant heterogeneity. Four studies were assessed as high RoB; sensitivity analyses excluding these provided comparable results for main outcomes. The main limitations include heterogeneity in BMS methodology between studies, low representation of populations most affected by cervical cancer, and insufficient data to assess survival outcomes.
UNASSIGNED: The addition of BMS to definitive CRT in cervical cancer patients decreases hematologic toxicity and the frequency of interruptions in concurrent chemotherapy. However, data are insufficient to verify the impact on survival and disease control.
摘要：
■同步放化疗（CRT）是局部晚期宫颈癌的标准治疗方法。我们调查了额外的骨髓保留（BMS）如何影响临床结果。
■我们查询MEDLINE，Embase,WebofScience核心合集,谷歌学者，Sinomed,CNKI,和万方数据库在2010/01/01和2023/10/31之间以英文或中文发表的文章。全文手稿的前瞻性，纳入了接受确定性或术后CRT治疗的宫颈癌患者BMS的随机试验.使用CochraneCollaboration的RoB工具评估偏倚风险(RoB)。随机效应模型用于荟萃分析。
■共17项试验，包括1297名患者。大多数是在中国进行的单中心试验（n=1268）（n=1128）。大多数试验使用基于CT的解剖BMS（n=1076）。在最终（n=655）和术后（n=582）设置中的试验具有可比性，其余试验包括两项.12项研究报告了G≥3（n=782）和G≥2（n=754）血液学不良事件的数据。G≥3(OR0.39;95%CI0.28-0.55;p<0.001)和G≥2(OR0.29;95%CI0.18-0.46;p<0.001)毒性均显著降低，有利于BMS。七项研究（n=635）报告了化疗中断的数据，定义为接受少于五个周期的顺铂，在接受BMS治疗的患者中，其频率显着降低（OR0.44；95％CI0.24-0.81；p=0.016）。没有证据表明胃肠道或泌尿生殖系统毒性增加。没有明显异质性的迹象。四项研究被评估为高RoB；排除这些研究的敏感性分析为主要结局提供了可比的结果。主要限制包括研究之间BMS方法的异质性，受宫颈癌影响最大的人群代表性低，和不足的数据来评估生存结果。
■在宫颈癌患者的确定性CRT中添加BMS降低了血液学毒性和同步化疗中断的频率。然而,数据不足以验证对生存率和疾病控制的影响。
■我们查询MEDLINE，Embase,WebofScience核心合集,谷歌学者，Sinomed,CNKI,和万方数据库在2010/01/01和2023/10/31之间以英文或中文发表的文章。全文手稿的前瞻性，纳入了接受确定性或术后CRT治疗的宫颈癌患者BMS的随机试验.使用CochraneCollaboration的RoB工具评估偏倚风险(RoB)。随机效应模型用于荟萃分析。
■共17项试验，包括1297名患者。大多数是在中国进行的单中心试验（n=1268）（n=1128）。大多数试验使用基于CT的解剖BMS（n=1076）。在最终（n=655）和术后（n=582）设置中的试验具有可比性，其余试验包括两项.12项研究报告了G≥3（n=782）和G≥2（n=754）血液学不良事件的数据。G≥3(OR0.39;95%CI0.28-0.55;p<0.001)和G≥2(OR0.29;95%CI0.18-0.46;p<0.001)毒性均显著降低，有利于BMS。七项研究（n=635）报告了化疗中断的数据，定义为接受少于五个周期的顺铂，在接受BMS治疗的患者中，其频率显着降低（OR0.44；95％CI0.24-0.81；p=0.016）。没有证据表明胃肠道或泌尿生殖系统毒性增加。没有明显异质性的迹象。四项研究被评估为高RoB；排除这些研究的敏感性分析为主要结局提供了可比的结果。主要限制包括研究之间BMS方法的异质性，受宫颈癌影响最大的人群代表性低，和不足的数据来评估生存结果。
■在宫颈癌患者的确定性CRT中添加BMS降低了血液学毒性和同步化疗中断的频率。然而,数据不足以验证对生存率和疾病控制的影响。
