Can the published data tell us about the effectiveness of neoadjuvant chemotherapy for locally advanced cancer of the uterine cervix?

The effect of neoadjuvant chemotherapy on survival of patients with locally advanced cervical cancer was investigated by conducting a systematic revie w and meta-analysis of the published data. Of the 21 randomised trials that we identified, only 15 were published. Furthermore, 2-year survival data c ould be extracted from only seven trial reports and 3-year survival from on ly nine trial reports. Meta-analyses of the published data at 2 and 3 years are neither clearly in favour of neoadjuvant chemotherapy nor control (2 y ears: odds ratio (OR) = 1.09, 95% confidence interval (CI) = 0.83-1.45, P = 0.37; 3 years: OR = 0.96, 95% confidence interval (CI) = 0.73-1.25, P = 0. 45). Being restricted to only some of the data from a relatively small frac tion of the randomised trials, these analyses potentially suffer from a num ber of biases and are therefore inconclusive. The only reliable way to judg e the value of neoadjuvant chemotherapy inn this disease is to perform a me ta-analysis of centrally collected, updated, individual data on all patient s from all known randomised trials. Such an analysis is currently being car ries out by an international collaborative group. (C) 1999 Elsevier Science Ltd. All rights reserved.