Survival Benefits of Neoadjuvant Chemotherapy Followed by Radical Surgery versus Radiotherapy in Locally Advanced Chemoresistant Cervical Cancer

The aim of this study was to analyze long-term survivals in patients with stage IB to IIA cervical cancer treated by neoadjuvant chemotherapy setting. Between February 1989 and January 1998, 94 women with previously untreated stage IB to IIA carcinoma of the uterine cervix who received cisplatin based neoadjuvant chemotherapy were enrolled in this study. All of patients with chemoresponse (complete response, n=15; partial response, n=47) and 16 patients with chemoresistance received radical surgery (RS group). The other 16 patients with chemoresistance received radiotherapy for definite treatment (RT group). In the RS group, the 10 yr survival estimation in patients with bulky tumors (diameter ≥4 cm, n=26) was similar to that with non-bulky tumors (83.3% vs. 89.3%, p=NS). In selected patients with chemoresistance, those treated by radiotherapy (n=16) showed significantly poorer survivals than those treated by radical surgery (n=16) [10 yr survival rates of RT (25%) vs. RS (76.4%), p=0.0111]. Our results support that a possible therapeutic benefit of neoadjuvant chemotherapy plus radical surgery is only in patients with bulky stage IB to IIA cervical cancer. In cases of chemoresistance, radical surgery might be a better definite treatment option

Bayesian one-step IPD network meta-analysis of time-to-event data using Royston-Parmar models

Network meta‐analysis (NMA) combines direct and indirect evidence from trials to calculate and rank treatment estimates. While modelling approaches for continuous and binary outcomes are relatively well developed, less work has been done with time‐to‐event outcomes. Such outcomes are usually analysed using Cox proportional hazard (PH) models. However, in oncology with longer follow‐up time, and time‐dependent effects of targeted treatments, this may no longer be appropriate. Network meta‐analysis conducted in the Bayesian setting has been increasing in popularity. However, fitting the Cox model is computationally intensive, making it unsuitable for many datasets. Royston‐Parmar models are a flexible alternative that can accommodate time‐dependent effects. Motivated by individual participant data (IPD) from 37 cervical cancer trials (5922 women) comparing surgery, radiotherapy, and chemotherapy, this paper develops an IPD Royston‐Parmar Bayesian NMA model for overall survival. We give WinBUGS code for the model. We show how including a treatment‐ln(time) interaction can be used to conduct a global test for PH, illustrate how to test for consistency of direct and indirect evidence, and assess within‐design heterogeneity. Our approach provides a computationally practical, flexible Bayesian approach to NMA of IPD survival data, which readily extends to include additional complexities, such as non‐PH, increasingly found in oncology trials