Evidence map›Paper›PMID 42012622›Full record

SynthesisInternational journal of clinical oncology2026

Optimal adjuvant strategy in intermediate-risk cervical cancer: a systematic review and meta-analysis.

Akira Yokoi, Hiroko Machida, Mika Okazawa-Sakai, Koji Nishino, Hanae Nishino, Mizue Itoi, Takumi Mitamura, Fumiaki Isohashi, Keisuke Tsuchida, Haruya Saji and 16 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in International journal of clinical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

26 authors.

Akira YokoiDepartment of Obstetrics and Gynecology, Nagoya University, Aichi, Japan.
Hiroko MachidaDepartment of Obstetrics and Gynecology, Tokai University School of Medicine, Shimokasuya, Isehara, Kanagawa, Japan. hiroko.machida@tokai.ac.jp.ORCID http://orcid.org/0000-0003-2252-3577
Mika Okazawa-SakaiDepartment of Gynecologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan.
Koji NishinoDepartment of Gynecologic Oncology, Niigata Cancer Center Hospital, Niigata, Japan.
Hanae NishinoDepartment of Obstetrics and Gynecology, Faculty of Medicine, Juntendo, University, Tokyo, Japan.
Mizue ItoiDepartment of Gynecologic Oncology, Chiba Cancer Center, Chiba, Japan.
Takumi MitamuraDepartment of Obstetrics and Gynecology, Hokkaido University Faculty of Medicine, Hokkaido University, Sapporo, Japan.
Fumiaki IsohashiDepartment of Radiation Oncology, Nara Medical University, Nara, Japan.
Keisuke TsuchidaDepartment of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
Haruya SajiDepartment of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
Satoe FujiwaraDepartment of Obstetrics and Gynecology, The University of Osaka Graduate School of Medicine, Osaka, Japan.
Noriko IiDepartment of Radiation Oncology, Ise Red Cross Hospital, Ise-shi, Japan.
Miho WatanabeDepartment of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Tadaaki NishikawaDepartment of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.
Satoshi NakagawaDepartment of Obstetrics and Gynecology, Osaka University, Osaka, Japan.
Michiko KodamaDepartment of Obstetrics and Gynecology, Osaka University, Osaka, Japan.
Shinya SatoDepartment of Obstetrics and Gynecology, Faculty of Medicine, Tottori University, Tottori, Japan.
Kazuhiro TakeharaDepartment of Gynecologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan.
Tohru MorisadaDepartment of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
Shin-Ei NodaDepartment of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan.
Munetaka TakekumaDepartment of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan.
Hiroaki KajiyamaDepartment of Obstetrics and Gynecology, Nagoya University, Aichi, Japan.
Hideki TokunagaDivision of Obstetrics and Gynecology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan.
Tsukasa BabaDepartment of Obstetrics and Gynecology, Iwate Medical University, Morioka, Iwate, Japan.
Yoichi KobayashiDepartment of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan.
Aikou OkamotoDepartment of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the efficacy and safety of adjuvant treatment strategies following radical hysterectomy for intermediate-risk, early-stage cervical cancer using a reconstructed HR Hazard ratio (HR) meta-analysis.

methodsA systematic review and meta-analysis was conducted by the Japan Society of Gynecologic Oncology Cervical Cancer Committee. PubMed/MEDLINE, Cochrane, and Ichushi were searched on July 29, 2025, using "cervical cancer," "intermediate-risk," and "adjuvant therapy." Studies comparing adjuvant radiotherapy alone (RT) with no further treatment (NFT), concurrent chemoradiotherapy (CCRT), or systemic chemotherapy (CT) after conventional radical hysterectomy were independently reviewed by two reviewers. Primary outcomes were survival and grade ≥ 3 treatment-related toxicities.

resultsOf 402 screened articles, 24 studies comprising 9278 patients were included: RT (n = 4167), NFT (n = 2057), CCRT (n = 2118), and CT (n = 936). The majority of studies enrolled patients with ≥ 2 Sedlis risk factors (median 84.2%, interquartile range 44.7-100%). Compared with NFT, RT significantly improved recurrence-free survival (HR 0.61, P < 0.01) but did not confer a significant overall survival benefit (HR 0.77, P = 0.09). RT also reduced recurrence in patients with a single risk factor (HR 0.55, P < 0.01). RT showed no survival disadvantage compared with CCRT (recurrence-free survival: HR 1.26; overall survival: HR 1.07), and survival outcomes were comparable between RT and CT (recurrence-free survival: HR 0.86; overall survival: HR 1.16) (all P > 0.05). Grade ≥ 3 toxicities were significantly lower with RT than with CCRT (odds ratio 0.25; P < 0.001).

conclusionAdjuvant RT represents an effective and well-tolerated postoperative strategy for intermediate-risk, early-stage cervical cancer. Adjuvant CT may represent a potential alternative option.

Indexed as

Chemoradiotherapy, AdjuvantUterine Cervical NeoplasmsChemotherapy, AdjuvantFemaleHumansHysterectomyNeoplasm Recurrence, LocalRadiotherapy, AdjuvantRisk FactorsCervical cancerComplicationsIntermediate-riskSurvivalSystematic review

Identifiers

PMID42012622
PMCPMC13201331

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.