A Cochrane review included 6 studies with a total of 1078 subjects. Both progression-free survival (HR 0.75, 95% CI 0.61 to 0.93, P = 0.008; 6 trials, n=986), and overall survival (HR 0.77, 95% CI 0.62 to 0.96, P = 0.02; 6 trials, n=1071) were significantly improved with neoadjuvant chemotherapy. The estimate for local recurrence was in favour of neoadjuvant chemotherapy, although heterogeneity was observed, and the result was no longer significant when the random-effects model was used. Whilst not significant, estimates for distant recurrence and rates of resection tended to favour neoadjuvant chemotherapy, although heterogeneity was observed. Post-hoc analyses of pathological response showed a significant decrease in adverse pathological findings with neoadjuvant chemotherapy (OR 0.54, 95% CI 0.39 to 0.73 for lymph node status; OR 0.58, 95% CI 0.41 to 0.82 for parametrial infiltration; n=903). There was also no difference in the effect of neoadjuvant chemotherapy according to total cisplatin dose, chemotherapy cycle length or by cervical cancer stage.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by inconsistency (variability in results of overall and progression-free survival).