title: Efficacy and toxicity of different concurrent chemoradiotherapy regimens in the treatment of advanced cervical cancer: A network meta-analysis.
abstract: OBJECTIVE
  The aim of this study was to compare the efficacy and toxicity of different concurrent chemoradiotherapy (CCRT) regimens in the treatment of advanced cervical cancer (CC) by adopting a network meta-analysis.
  
  
  METHODS
  We searched PubMed and Cochrane Library from the inception of these databases to September 2016, and all cohort studies (CSs) related to different CCRT regimens in the treatment of CC were included. A network analysis was adopted to compare the combination of direct and indirect evidence, to analyze the odds ratio (OR), and to draw a surface under the cumulative ranking curve of the efficacy and toxicity of different CCRT regimens for CC. Cluster analyses were used to group each category based on similar treatment regimens.
  
  
  RESULTS
  Nineteen CSs were enrolled in this network meta-analysis, including 12 CCRT regimens (radiotherapy [RT], CCRT [cisplatin], CCRT [vinorelbine], CCRT [paclitaxel], CCRT [hydroxyurea], CCRT [cisplatin + FU], CCRT [cisplatin + gemcitabine], CCRT [cisplatin + docetaxel], CCRT [cisplatin + paclitaxel], CCRT [cisplatin + amifostine], CCRT [cisplatin + FU + hydroxyurea], and CCRT [cisplatin + vincristine + bleomycin]). The results of the network meta-analysis showed that regarding efficacy, the overall response rate of CCRT (cisplatin + docetaxel) was higher than RT, and the 5-year overall survival (OS) rate of CCRT (cisplatin + FU + hydroxyurea) was relatively higher than CCRT (hydroxyurea). As for toxicity, CCRT (cisplatin) had a lower incidence of leukopenia than CCRT (hydroxyurea), CCRT (cisplatin + FU) and CCRT (cisplatin + paclitaxel), and the incidences of diarrhea and vomiting in CCRT (cisplatin) were lower than those in CCRT (cisplatin + gemcitabine). Additionally, the cluster analysis showed that CCRT (cisplatin) had relatively lower incidences of both hematotoxicity and gastrointestinal toxicity, and CCRT (paclitaxel) had lower gastrointestinal toxicity than other regimens.
  
  
  CONCLUSIONS
  Our study demonstrated that CCRT (cisplatin + docetaxel) might be the best choice of CCRT regimens in the treatment of CC, and the 5-year OS rate of CCRT (cisplatin + FU + hydroxyurea) might be the highest among these different regimens. CCRT (cisplatin) might have the lowest toxicity among all the CCRT regimens.
authors.affiliation: aDepartment of Radiotherapy, the First Hospital of Qinhuangdao bYanshan University cDepartment of Biomedical Engineering, Yanshan University dThe First Hospital of Qinhuangdao eDepartment of Gynaecology, the First Hospital of Qinhuangdao, Qinhuangdao, P.R. China. .
authors.forename: Zhan-Zhao
authors.initials: ZZ
authors.lastname: Fu
authors.forename: Kun
authors.initials: K
authors.lastname: Li
authors.forename: Yong
authors.initials: Y
authors.lastname: Peng
authors.forename: Yue
authors.initials: Y
authors.lastname: Zheng
authors.forename: Li-Yan
authors.initials: LY
authors.lastname: Cao
authors.forename: Yun-Jie
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Sun
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000628:therapy*