Summary of findings 4. Hysterectomy (simple or radical) with chemoradiotherapy versus chemoradiotherapy alone.

Hysterectomy (simple or radical) with chemoradiotherapy versus chemoradiotherapy alone
Patient or population: women with locally advanced cervical cancer Settings: outpatient Intervention: chemoradiotherapy + hysterectomy (simple or radical) Comparison: chemoradiotherapy alone
Outcomes	Relative effect	No of participants	Certainty of the evidence (GRADE)	Comments
Overall survival Median follow‐up 3.8 years	Overall survival was inadequately reported and it was not possible to calculate a hazard ratio. Overall survival time in the chemoradiotherapy + hysterectomy group was 6–40 months, median survival time was 23 months, and 3‐year survival rate was 82.7%. Total survival time in the chemoradiotherapy group was 5–41 months, median survival time was 22.5 months and 3‐year survival rate was 81.8%. Trial authors reported differences between arms were not statistically significant (P = 0.56).	102 (1 RCT)	⊕⊝⊝⊝ Very lowa,b	—
Progression or event‐free survival Median follow‐up 3.8 years	Progression‐free survival was inadequately reported in both trials and it was not possible to calculate a hazard ratio. In 1 trial, progression‐free survival time in the chemoradiotherapy + hysterectomy group was 3–40 months, median survival time was 23 months and 3‐year survival rate was 73.1%. The progression‐free survival time in the chemoradiotherapy alone group was 5–41 months, median survival time was 22 months and 3‐year survival rate was 64.8%. There was no significant difference between arms (P = 0.76). Another trial included 61 women and compared chemoradiotherapy + simple or radical hysterectomy vs chemoradiotherapy alone. There was no difference in 3‐year event‐free (death) survival rate (86% in the chemoradiotherapy + hysterectomy group vs 97% in the chemoradiotherapy alone group; log rank P = 0.15).	163 (2 RCT)	⊕⊝⊝⊝ Very lowa,b	—
Quality of life	—	—	—	Not adequately reported.
Severe/serious adverse events	—	—	—	Not adequately reported.
RCT: randomised controlled trial.
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 two levels due to sparse data leading to imprecision.
^bDowngraded one level due to small number of trials and a lack of representation.