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    <pre style="white-space:pre-line"><code>NEOPLASIE DELLâ€™UTERO: ENDOMETRIO E CERVICE  LINEE GUIDA
                                                  2018

Quesito:
    La chemioterapia neoadjuvante prima della chirurgia migliora la sopravvivenza rispetto alla sola
    chirurgia nel carcinoma della cervice uterina?

Descrizione delle evidenze:
Lo studio pubblicato da:

    â€¢ Rydzewska L, 2012
condotto in termini di:

    â€¢ revisione sistematica
con disegno:

    â€¢ di tipo comparativo: superioritÃ 
su un campione di:

    â€¢ 1078 pazienti
osservati in

    â€¢ nÂ° 6 studi
con criteri di selezione:

    â€¢ carcinoma della cervice allo stadio iniziale o localmente avanzato

avente come obiettivo la valutazione di:
    â€¢ definire il ruolo della chemioterapia neoadjuvante prima della chirurgia

da condurre sugli outcome:
    â€¢ OS
    â€¢ PFS

ha evidenziato:
    â€¢ OS: HR 0.77 95% CI 0.62 to 0.96, P = 0.02
    â€¢ PFS HR 0.75, 95% CI 0.61 to 0.93, P = 0.008 entrambe in favore della chemioterapia
         neoadjuvante

Sono state rilevate le seguenti limitazioni:
    â€¢ Gli studi considerati includevano sia pazienti in stadio iniziale sia pazienti con malattia localmente
         avanzata. Non eâ€™possibile pertanto stabilire quale sia il contributo della chemioterapia
         neoadjuvante nei diversi stadi di malattia

   QualitÃ      Raccomandazione clinica                                        Forza della
dellâ€™evidenza                                                             raccomandazione

    SIGN                                                                         clinica

               La chemioterapia neoadiuvante determina un vantaggio

B              sia in termini di OS sia di sopravvivenza libera da        Positiva forte

               progressione rispetto alla sola chirurgia primaria. (90)

               80</code></pre>
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