Efficacy of induction chemotherapy combined with standard chemoradiotherapy vs. standard chemoradiotherapy monotherapy in locally advanced cervical cancer:  A systematic review and meta-analysis.

Abstract

Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced cervical cancer (LACC); however, the role of additional induction chemotherapy (IC) remains debated. The present study performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to comparatively assess therapeutic outcomes and safety profiles between induction chemotherapy followed by concurrent chemoradiotherapy (IC + CCRT) versus CCRT alone in patients with locally advanced cervical cancer (LACC) (International Federation of Gynecology and Obstetrics 2018 stage IB2-IVA). The study screened relevant literature published up to March 2025 and ultimately included 6 RCTs, where 1,006 patients were stratified (504 in the IC + CCRT regimen vs. 502 in the CCRT alone regimen). Compared with CCRT alone, IC + CCRT significantly improved the complete response (CR) rate [odds ratio (OR), 1.95; 95% confidence interval (CI), 1.20-3.17; P=0.007] and 1-year progression-free survival rate (OR, 1.82; 95% CI, 1.14-2.90; P=0.01). A consistent trend favoring IC+CCRT was observed for overall survival, although this was not statistically significant. Hematological toxicities, notably thrombocytopenia (OR, 1.76; 95% CI, 1.06-2.90; P=0.03) and neutropenia (OR, 2.69; 95% CI, 1.09-6.61; P=0.03), were more frequent with IC+CCRT, while non-hematological toxicity profiles were comparable. In conclusion, the addition of modern, short-course induction chemotherapy to CCRT enhances the CR rate and 1-year progression-free survival rate in LACC, establishing a promising intensified treatment strategy.