Overall treatment time and oncologic outcomes after definitive radiotherapy or chemoradiotherapy for cervical cancer: a systematic review and meta-analysis

Abstract

Prolonged overall treatment time (OTT) during definitive radiotherapy has long been considered detrimental in cervical cancer, but the magnitude and consistency of its prognostic association across treatment eras remain uncertain. We evaluated the association between OTT and oncologic outcomes after definitive radiotherapy or chemoradiotherapy. PubMed/MEDLINE, Embase, Web of Science Core Collection, Scopus, and the Cochrane Library were searched from inception through August 1, 2026. Eligible studies assessed OTT from initiation of external-beam radiotherapy through completion of the planned definitive radiotherapy course as either a categorical or continuous prognostic factor. Risk of bias was assessed using the Quality In Prognosis Studies tool. Time-to-event estimates were pooled as hazard ratios (HRs) with 95% confidence intervals (CIs) using random-effects models. Nineteen studies comprising 15,859 patients were included. Ten independent cohorts contributed to the primary overall survival (OS) analysis. Prolonged OTT was associated with poorer OS (HR, 1.61; 95% CI, 1.30–1.99; I² = 76%). In the prespecified analysis of three independent cohorts comparing OTT >56 versus ≤56 days, the association persisted (HR, 1.16; 95% CI, 1.04–1.31; I² = 37%). Prolonged OTT was also associated with a higher risk of local/pelvic/in-field failure (HR, 1.80; 95% CI, 1.26–2.56; I² = 46%). The OS association was consistent across treatment-era and cutoff-source subgroups and remained robust in sensitivity analyses. Prolonged OTT is associated with poorer survival and a higher risk of local/pelvic/in-field failure after definitive radiotherapy or chemoradiotherapy for cervical cancer. These findings support timely completion of definitive radiotherapy and indicate that the 56-day interval remains a clinically relevant benchmark. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261470588 , identifier CRD420261470588.