Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_14_3453 - Therapeutic Options for Locally Advanced Cervix Cancer: A Systematic Review and Network Meta-analysis

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Therapeutic Options for Locally Advanced Cervix Cancer: A Systematic Review and Network Meta-analysis
N. R. Datta, E. Stutz, S. Gomez, and S. B. Bodis; Kantonsspital Aarau, Aarau, Switzerland

Purpose/Objective(s): Therapeutic strategies in locally advanced cancer cervix (LACC), (IIB-IVA) have primarily evolved around radiotherapy (RT) and/or chemotherapy (CT). Neoadjuvant CT (NACT), adjuvant CT (ACT), concurrent CT (CTRT) and other modalities like hypoxic cell sensitizers including hyperbaric oxygen (HypCS), immunotherapy (Imm) and hyperthermia (HT) have been also tried either with RT alone or in combinations. A systematic review and network meta-analysis (NMA) was conducted to synthesize the evidence for the most appropriate treatment option for each of the four endpoints - long-term loco-regional control (LRC), overall survival (OS), grade III+ acute (AT) and late toxicity (LT) in LACC.

Materials/Methods: Five major databases were searched as per the PRISMA guidelines. 6284 articles were mined. Only randomized trials in previously untreated LACC, without surgical interventions published in English were selected. Each article was assessed for risk of bias using Cochrane collaboration tool. Outcomes of therapeutic interventions for each of the endpoints were computed using random effects model. Initially a conventional meta-analysis was performed for trials with direct comparative arms. Subsequently network diagrams, league tables, pair-wise forest plots with odds ratio (95% Cr.I) and inconsistency plots between all possible direct and indirect interventions were generated using NMA. Treatment options were ranked according to their respective surface under the cumulative ranking curve (SUCRA) values, indicating the order of their most pronounced impact on each of the outcomes.

Results: 60 articles were finally shortlisted. Based on their individual control or study groups, interventions were classified into 13 groups - RT alone, CTRT (weekly cisplatin, CDDP), CTRT (3 weekly CDDP), CTRT (non-CDDP), CTRT (combination CDDP), CTRT+ACT, RT+ACT, HTRT, HTCTRT, RT+HypCS, RT+Imm, NACT+RT and NACT+RT+ACT. A total of 9094 patients were included (LACC: 97.4%; squamous cell cancer: 93.9%). The number of two-arm studies were 47, 49, 43 and 30 for LRC, OS, AT and LT respectively. One study had four treatment arms. The total reported events to number of patients for each endpoint were - LRC (4954/7347); OS (4124/7164); AT (1041/6284) and LT (366/5378). SUCRA values varied for each endpoint, the highest being HTRT for LRC (0.83), CTRT (3 weekly CDDP) for OS (0.89), RT+ACT for AT (0.98) and NACT+RT+ACT for LT (0.80). The top three average SUCRA values including all the endpoints were - HTRT (0.66), HTCTRT (0.63) and CTRT (3 weekly CDDP) (0.62).

Conclusion: Loco-regional moderate HT at 39-43°C is a potent radiosensitizer, exhibits thermal synergism with CT agents and has immunomodulatory properties. The highest overall SUCRA values from NMA indicates HTRT/HTCTRT to have the most pronounced comprehensive positive impact on key clinical endpoints in LACC. The evidence merits future phase III randomized trials with HTRT/HTCTRT and CTRT (3 weekly CDDP) in LACC to further corroborate these findings.

Author Disclosure: N.R. Datta: None. E. Stutz: None.

Niloy Datta, MD

Biography:
Prof. Niloy Ranjan Datta, MD, DNB, CCST Senior Consultant, Radiation Oncology and Head, Radiation Oncology Research Program, Kantonsspital Aarau, Aarau, Switzerland is involved in the field of radiation oncology for the past 36 years.

Prior to his joining at the present position in 2012, he was the Professor and Head of Department of Radiation Oncology at premier tertiary care teaching, training and research institutions in India (SGPGIMS, Lucknow and RGCRI, Delhi). He was also a Consultant to the Programme of Action for Cancer Therapy (PACT) of the International Atomic Energy Agency (IAEA), Vienna and had contributed to setting up radiation oncology centers in various developing countries of Asia and Africa. This involved utilizing teleradiotherapy network to provide a cost effective radiation oncology setup for clinical, teaching and training in developing countries. He has also actively participated in various training programs conducted by the Applied Radiobiology and Radiotherapy (ARBR) Section of the IAEA and was consultant for framing the “IAEA Syllabus for the Education and Training of Radiation Oncologist”. He was also a member of the Task force and Technical Advisory Committee of the Ministry of Health and Family Welfare, Govt. of India for planning and development of radiotherapy services in India for the XIth five-year plan (2007-2011) under the National Cancer Control Programme (NCCP).

His primary sites of interest have been cervix, head and neck, prostate and breast cancers. He is also active in clinical hyperthermia research, meta-analysis, and radiotherapy infrastructure and human resources in low-middle income group countries. He has contributed more than 150 full length articles in various peer reviewed journals and has been invited for orations / invited lectures at various national and international conferences. A number of national and international awards have been bestowed on him for his contributions in research and training in radiation oncology.

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