CRITICAL APPRAISAL

SECTION A: Are the results of the study valid?

No Yes Can’t Tell No

1 Did the review address a clearly focused V
question?
2 Was the cohort recruited in an acceptable way ? V
3 Was the exposure accurately measured to V
minimise bias ?
4 Was the outcome accurately measured to V
minimise bias ?
5a Have the authors identified all important V
confounding factors ?
5b Have they taken account of the confounding
factors in the design and/or analysis ?
6a Was the follow up of subjects complete enough ?

6b Was the follow of subjects long enough ?

SECTION B: What are the results?

No Yes Can’t Tell No

7 What are the results of this study ? V
8 How precise are the results ? V
9 Do you believe this results ?

SECTION C: Will the results help locally?

No Yes Can’t Tell No

10 Can the results be applied to the local population? V
11 Do the results of this study fit with other available V
evidence?
12 What are the implications of this study for V
practice?
1. Did the review address a clearly focused question?
Yes, This study compared the outcome of CT group and RT group as adjuvant therapy for
patients with FIGO stage IB-IIB cervical cancer and surgically confirmed intermediate-
risk factors.

2. Was the cohort recruited in an acceptable way ?

Yes, the population of the study underwent radical hysterectomy with removal of a vaginal
cuff of at least 3 cm, total resection of parametrial tissue, and systematic pelvic lympha-
denectomy.
Some of the population received chemotherapy instead of radiation therapy.
119 subjects were obtained, 73 who received chemotherapy (CT), 30 received
radiotherapy (RT), 16 did not received adjuvant therapy (observation group).

3. Was the exposure accurately measured to minimize bias ?

Yes, the exposures of these study include chemotherapy which was tailored to each of
patients requirement. The patients on this study were examined preoperatively and staged
according to FIGO standard.

4. Was the outcome accurately measured to minimize bias?

Yes, the treatment outcomes were assessed using overall survivor rate, and incindence of
reccurence and relaps.

5. a. Have the author identified all important caonfounding factors?

Yes, all possible confounding factors for the outcome of cervical cancer survival rate were
assessed in this study, such as, stage, cell type, differentiation, age, bulky tumor (>4 cm),
LVSI, DSI, positive lymph nodes, positive parametria, and positive surgical margins.

b. Have they taken account of the confounding factors in the design and/or analysis?
Can’t tell, the study was a retrospective study, authors may not have taken account of the
confounding factors.

6. a. Was the follow up of subjects complete enough?

No, this study was only examine the outcome by Overall Survival (OS)
 b. Was the follow up of subject long enough ?
Yes, the study is reviewed the medical records retrospectively from December 1997 to
September 2010

7. What are the results of this study ?

CT may have equivalent therapeutic effect as RT for stage IB-IIB cervical cancer patients
with intermediate-risk factors after radical surgery, and prospective randomized trial is
needed to study the effect of CT in these patients.

8. How precise are the results ?

Statistical analysis show that no significant difference were found between the outcome of
two different kind of adjuvant therapy (CT & RT).

9. Do you believe the results ?

Yes, the statistical result of this study show that there was no significant difference
between CT and RT group, underlining the fact that CT is equivalent to RT in the outcome
of cervical cancer trestment. This finding may warrant a further research in choosing CT
as an alternative treatment for cervical cancer with young age.

10. Can the results be applied to the local population?

Yes, the study can be applied to patients in Adam Malik General Hospital, where the
majority of the patients came with advance stage of cervical cancer.

11. Do the results of this study fit with other available evidence?
Can’t tell, there are limited amount of evidence and study about these subject. In other
hand, chemotherapy was usually reserved for neo-adjuvant therapy.

12. What are the implications of this study for practice ?

Yes, from this study we can conclude that chemotherapy can replace radiotherapy as
adjuvant therapy in cervical cancer. the use of chemotherapy may reduce the incidence of
premature ovarian failure in younger age patient.