Impact of local treatment in overall survival in patients with metastatic cervical cancer: a systematic review and meta-analysis

Introduction: Local treatments, such as definitive pelvic radiation or local surgery, are often used to reduce morbidity and tumor progression in metastatic cervical cancer. However, the impact of these treatments on overall survival in stage IVB cervical cancer remains uncertain.

Objective: This systematic review and meta-analysis aims to evaluate the effect of local treatment on overall survival (OS) and progression-free survival (PFS) compared with systemic treatment alone in patients with metastatic cervical cancer.

Methods: We searched MEDLINE, Cochrane, and EMBASE to identify studies comparing local treatment in stage IVB cervical cancer versus systemic treatment alone up to March 2024. The primary outcomes of interest were OS and PFS. We performed statistical analyses using R Studio and RevMan 5.4.1. We pooled hazard ratios (HR) for OS and PFS and odds ratios (OR) for other binary outcomes with a random-effects model. We defined a significant threshold as a p-value < 0.05. We assessed heterogeneity using I² statistics, with I² > 25% being defined as high heterogeneity. The PROSPERO registration is CRD42024541408.

Results: We included six studies with a total of 3,033 patients, of whom 1,311 (43.2%) received local treatment, and 1,722 (56.7%) were in the systemic treatment group. Squamous cell carcinoma accounted for 74.3% of the diagnoses. In the control group, 784 (45.5%) patients received palliative radiotherapy concurrent with systemic treatment. Patients in the local treatment group had significantly better OS (HR: 0.524; 95% CI: 0.355 – 0.772; p = 0.001) and PFS (HR: 0.305; 95% CI: 0.098 – 0.955; p = 0.042) compared with those who received systemic therapy alone. Partial response (OR: 0.53; 95% CI: 0.10-2.73; p = 0.45), complete response (OR: 3.37; 95% CI: 0.00-2394.6; p = 0.72), and disease recurrence (OR: 0.38; 95% CI: 0.07 – 1.97; p = 0.25) were similar in both groups.

Conclusions: Our systematic review and meta-analysis support the use of local treatment, either definitive pelvic radiation or surgery, as part of the management of metastatic cervical cancer. Local treatment significantly improved OS and PFS compared to patients receiving systemic therapy alone.

Corresponding author: Fabíola Furtuoso Zarpelão (e-mail: fabiola.sfurtuoso@gmail.com).