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Definitive pelvic radiotherapy for patients with newly diagnosed stage IVB cervical cancer: a systematic review
  1. David Viveros-Carreño1,2,
  2. Santiago Vieira-Serna2,
  3. Carlos Fernando Grillo - Ardila3,
  4. Juliana Rodriguez1,3,4,
  5. Nathalia Mora-Soto1,
  6. Anuja Jhingran5,
  7. Pedro T Ramirez6 and
  8. Rene Pareja7
  1. 1Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
  2. 2Department of Gynecologic Oncology, Clínica Universitaria Colombia, Bogotá, Colombia
  3. 3Department of Obstetrics and Gynecology, Universidad Nacional de Colombia, Bogotá, Colombia
  4. 4Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
  5. 5Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  6. 6Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
  7. 7Department of Gynecologic Oncology, Clínica Astorga, Medellin, Colombia
  1. Correspondence to Dr David Viveros-Carreño, Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá 508-509, Colombia; dviverosc{at}


Objective The objective of this systematic review was to assess the oncologic outcomes of patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IVB cervical cancer receiving definitive pelvic radiotherapy compared with systemic chemotherapy (with or without palliative pelvic radiotherapy).

Methods This study was registered in PROSPERO (registration number CRD42022333433). A systematic literature review was conducted following the MOOSE checklist. MEDLINE (through Ovid), Embase, and Cochrane Central Register of Controlled Trials were searched from inception until August 2022. The inclusion criteria were patients with metastatic FIGO 2018 stage IVB cervical cancer, a histologic subtype of squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma that received definitive pelvic radiotherapy (≥45 Gy) as part of management compared with systemic chemotherapy with or without palliative (30 Gy) pelvic radiotherapy. Randomized controlled trials and observational studies with two arms of comparison were considered.

Results The search identified 4653 articles; 26 studies were considered potentially eligible after removing duplicates, and 8 met the selection criteria. In total, 2424 patients were included. There were 1357 and 1067 patients in the definitive radiotherapy and chemotherapy groups, respectively. All included studies were retrospective cohort studies, and two were database population studies. The median overall survival reported in seven studies for the definitive radiotherapy arm versus systemic chemotherapy groups were 63.7 months versus 18.4 months (p<0.01), 14 months versus 16 months (p value not reported), 17.6 months versus 10.6 months (p<0.01), 32 months versus 24 months (p<0.01), 17.3 months versus 10 months (p<0.01), and 41.6 months versus 17.6 months (p<0.01), and not reached versus 19 months (p=0.13) respectively, favoring the groups that received definitive pelvic radiotherapy. The high clinical heterogeneity precluded the performance of meta-analysis, and all studies were at serious risk of bias.

Conclusions Definitive pelvic radiotherapy as part of treatment in patients with stage IVB cervical cancer may improve oncologic outcomes compared with systemic chemotherapy (with or without palliative radiotherapy); however, this is based on low-quality data. Prospective evaluation would be ideal before the adoption of this intervention in standard clinical practice.

  • Cervical Cancer
  • Radiotherapy

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors DV-C: conceptualization, investigation, methodology, writing - original draft, writing - review and editing. Responsible for the overall content as the guarantor. SV-S: investigation, data curation, writing - review. CFG-A: methodology, formal analysis. JR: data curation, formal analysis, methodology, N-MS: writing - original draft, writing - review and editing. AJ: writing - review and editing. PTR: writing - review and editing, supervision. RP: conceptualization, methodology, formal analysis, writing - review and editing, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.