Adjuvant Therapy in "Intermediate-Risk" Early-Stage Cervical Cancer: To Treat or Not to Treat? Systematic Review and Meta-Analysis.

International guidelines do not take a clear position regarding the management of patients with "intermediate-risk" cervical cancer, and they remain noncommittal on the necessity of adjuvant therapy following radical hysterectomy. To determine if adjuvant therapy after surgery adds benefit in "intermediate-risk" cervical cancer patients in terms of recurrence rate and mortality rate, we performed a systematic review with meta-analysis on Google Scholar, PubMed, and Scopus. The inclusion criteria were studies with >100 patients with intermediate-risk cervical cancer according to the Sedlis criteria, RCTs, or propensity score-matched cohort studies reporting oncological outcomes and treatment-related toxicity, comparing a surgery-only cohort with an adjuvant therapy cohort. We found 11 studies that met our inclusion criteria, comprising a total of 4011 patients. The mean follow-up was 80.7 months. No statistically significant differences were found for both outcomes, respectively, recurrence rate OR 0.92 (95% CI 0.70-1.20, I 38%) and mortality rate OR 1.05 (95% CI 0.77-1.46, I 41%). However, a statistically significant difference was found in the site of recurrence-pelvic OR 0.48 (95% CI 0.23-0.98, < 0.001, I 42%) or distant OR 2.10 (95% CI 1.02-4.33, < 0.001 I 42%). Treatment-related risk of Grade 3 or 4 toxicity was statistically significant. Our meta-analysis shows that oncological outcomes in this class of patients are similar between the two groups. However, while awaiting the results of new RCTs, it is crucial to define a personalized diagnostic and therapeutic strategy for each patient.