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.

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 (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, 9(8), e028008. BMJ Publishing Group 10.1136/bmjopen-2018-028008

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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Literature searches in electronic databases (CENTRAL, MEDLINE, EMBASE) or trial registries will identify published and unpublished randomised controlled trials (RCTs) and cohort studies comparing the efficacy and complications among different excisional and ablative techniques.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.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Efthimiou, Orestis and Salanti, Georgia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2044-6055

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

08 Aug 2019 13:02

Last Modified:

24 Oct 2019 19:02

Publisher DOI:

10.1136/bmjopen-2018-028008

PubMed ID:

31377697

Uncontrolled Keywords:

Ablation techniques/adverse effects Cervical intraepithelial neoplasia/therapy Conization/adverse effects Recurrence Treatment outcome

BORIS DOI:

10.7892/boris.132356

URI:

https://boris.unibe.ch/id/eprint/132356

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