Summary of findings 2. Hysterectomy (simple or radical) with neoadjuvant chemotherapy versus radiotherapy alone for women with locally advanced cervical cancer.
| Hysterectomy (simple or radical) with neoadjuvant chemotherapy versus radiotherapy alone for women with locally advanced cervical cancer | ||||
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Patient or population: women with locally advanced cervical cancer Settings: outpatient Intervention: neoadjuvant chemotherapy + radical hysterectomy Comparison: radiotherapy alone | ||||
| Outcomes | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments |
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Overall survival Median follow‐up 39–60 months in the 3 trials |
HR 0.71 (0.55 to 0.93) | 571 (3 RCTs) | ⊕⊕⊕⊝ Moderatea | — |
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Disease‐ or progression‐free survival Median follow‐up 39–60 months in the 3 trials |
HR 0.75 (0.53 to 1.05) | 571 (3 RCTs) | ⊕⊕⊕⊝ Moderatea | There were varying definitions of disease‐ and progression‐free survival. However, we did not consider this merited further downgrading to low‐certainty evidence. |
| Quality of life | — | — | — | Not reported. |
| Severe adverse events and toxicity |
Acute severe toxicity RR 1.32 (0.47 to 3.71) |
118 (1 RCT) |
⊕⊕⊝⊝ Lowb | — |
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Long‐term severe complications RR 0.86 (0.49 to 1.50) |
409 (1 RCT) |
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Severe late toxicity RR 0.60 (0.27 to 1.34) |
118 (1 RCT) |
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| CI: confidence interval; HR: hazard ratio; RCT: randomised controlled trial; RR: risk ratio. | ||||
| GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate. | ||||
aDowngraded one level due to concerns regarding the uncertainty of risk of bias in individual trials. bDowngraded two levels due to incomplete and poor reporting of important adverse events and toxicities and sparseness of data.