Comparative efficacy and complication rates after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer : protocol for a systematic review and network meta-analysis from the CIRCLE Group

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Athanasiou , A , Veroniki , A A , Efthimiou , O , Kalliala , I , Naci , H , Bowden , S , Paraskevaidi , M , Martin-Hirsch , P , Bennett , P , Paraskevaidis , E , Salanti , G & Kyrgiou , M 2019 , ' Comparative efficacy and complication rates after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer : protocol for a systematic review and network meta-analysis from the CIRCLE Group ' , BMJ Open , vol. 9 , no. 8 , e028008 . https://doi.org/10.1136/bmjopen-2018-028008

Title: Comparative efficacy and complication rates after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer : protocol for a systematic review and network meta-analysis from the CIRCLE Group
Author: Athanasiou, Antonios; Veroniki, Areti Angeliki; Efthimiou, Orestis; Kalliala, Ilkka; Naci, Huseyin; Bowden, Sarah; Paraskevaidi, Maria; Martin-Hirsch, Pierre; Bennett, Philip; Paraskevaidis, Evangelos; Salanti, Georgia; Kyrgiou, Maria
Contributor organization: Clinicum
Department of Obstetrics and Gynecology
HUS Gynecology and Obstetrics
University of Helsinki
Date: 2019-08
Language: eng
Number of pages: 7
Belongs to series: BMJ Open
ISSN: 2044-6055
DOI: https://doi.org/10.1136/bmjopen-2018-028008
URI: http://hdl.handle.net/10138/309745
Abstract: Introduction Local treatments for cervical intraepithelial neoplasia (CIN) and microinvasive disease remove or ablate a cone-shaped part of the uterine cervix containing the abnormal cells. A trend toward less radical techniques has raised concerns that this may adversely impact the rates of precancerous and cancerous recurrence. However, there has been no strong evidence to support such claims. We hereby describe a protocol of a systematic review and network meta-analysis that will update the evidence and compare all relevant treatments in terms of efficacy and complications. Methods and analysis Literature searches in electronic databases (CENTRAL, MEDLINE, EMBASE) or trial registries will identify published and unpublished randomised controlled trials (RCTs) and cohort studies comparing the efficacy and complications among different excisional and ablative techniques. The excisional techniques include cold knife, laser or Fischer cone, large loop or needle excision of the transformation zone and the ablative radical point diathermy, cryotherapy, cold coagulation or laser ablation. The primary outcome will be residual/recurrent disease defined as abnormal histology or cytology of any grade, while secondary outcomes will include treatment failure rates defined as high-grade histology or cytology, histologically confirmed CIN1+ or histologically confirmed CIN2+, human papillomavirus positivity rates, involved margins rates, bleeding and cervical stenosis rates. We will assess the risk of bias in RCTs and observational studies using tools developed by the Cochrane Collaboration. Two authors will independently assess study eligibility, abstract the data and assess the risk of bias. Random-effects meta-analyses and network meta-analyses will be conducted using the OR for dichotomous outcomes and the mean difference for continuous outcomes. The quality of the evidence for the primary outcome will be assessed using the CINeMA (Confidence In Network Meta-Analysis) tool. Ethics and dissemination Ethical approval is not required. We will disseminate findings to clinicians, policy-makers, patients and the public. PROSPERO registration number CRD42018115508.
Subject: Cervical intraepithelial neoplasia
therapy
Treatment outcome
Recurrence
Conization
adverse effects
Ablation techniques
LOOP ELECTROSURGICAL EXCISION
MULTIPLE-TREATMENTS
HETEROGENEITY
INCONSISTENCY
PROPORTION
LESIONS
TRIALS
EXTENT
RISK
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Rights: unspecified
Usage restriction: openAccess
Self-archived version: publishedVersion


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