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Impact of intracavitary brachytherapy technique (2D versus 3D) on outcomes of cervical cancer: a systematic review and meta-analysis

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Abstract

Purpose

To perform a systematic review and meta-analysis of the impact of brachytherapy (BT) technique (two-dimensional [2D] or three-dimensional image-guided [3D]) on outcomes of cervical cancer patients.

Methods

PubMed and EMBASE databases were searched up to April 16, 2019, for studies which evaluated the effect of 3D-BT compared to 2D-BT in cervical cancer. Endpoints included cumulative incidence of severe toxicity, locoregional recurrence-free survival (LRRFS), progression-free survival (PFS), and overall survival (OS). Hazard ratios (HRs) were pooled in the meta-analysis using the random-effects model.

Results

Six studies of eight cohorts were included in the quantitative synthesis. The pooled HR regarding toxicity was evaluated in five cohorts in three studies, and the HR of 3D-BT compared to 2D-BT was 0.54 (95% confidence interval [CI] 0.37–0.77). All six studies were included for the synthesis for LRRFS, and the pooled HR favors 3D-BT (0.61 [95% CI 0.40–0.93]). For PFS, three studies were included for analysis and 3D-BT was superior to 2D-BT (HR = 0.75 [95% CI 0.59–0.96]). Five studies were included for the pooled HR regarding OS, and pooled HR of 3D-BT compared to 2D-BT was 0.65 (95% CI 0.40–1.06).

Conclusion

3D-BT might reduce severe toxicity and improve LRRFS and PFS in patients with cervical cancer. 3D-BT should be considered for standard management of cervical cancer, and efforts for adopting this procedure in Korea should be pursued.

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Abbreviations

BT:

Brachytherapy

CI:

Confidence interval

CIs:

Confidence intervals

CT:

Computed tomography

CTCAE:

Common Terminology Criteria for Adverse Events

EBRT:

External beam radiotherapy

EMBRACE:

Image-guided intensity-modulated external beam radiochemotherapy and MRI-based adaptive brachytherapy in locally advanced cervical cancer

GEC-ESTRO:

Groupe Européen de Curiethérapie/European Society for Therapeutic Radiology and Oncology

HR:

Hazard ratio

HRs:

Hazard ratios

IMRT:

Intensity-modulated radiotherapy

LRRFS:

Locoregional recurrence-free survival

MRI:

Magnetic resonance imaging

OAR:

Organs at risk

OS:

Overall survival

PICOS:

Patient/Intervention/Comparator/Outcome/Study

PFS:

Progression-free survival

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

QUIPS:

Quality in Prognostic Studies

RTOG/EORTC:

Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer

STIC:

Soutien aux Techniques Innovantes et Coûteuses

2D:

Two-dimensional

3D:

Three-dimensional

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Authors and Affiliations

  1. Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)

    Yeon Joo Kim & Young Seok Kim

  2. Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea (Republic of)

    Hyun-Cheol Kang

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Contributions

Y.J. Kim and H.-C. Kang participated in data acquisition and analysis, literature research, and drafting of the manuscript. Y.S. Kim contributed to the conception and design of the study and revised the manuscript.

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Correspondence to Young Seok Kim.

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Conflict of interest

Y.J. Kim, H.-C. Kang and Y.S. Kim declare that they have no competing interests.

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Availability of data and materials

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Kim, Y.J., Kang, HC. & Kim, Y.S. Impact of intracavitary brachytherapy technique (2D versus 3D) on outcomes of cervical cancer: a systematic review and meta-analysis. Strahlenther Onkol 196, 973–982 (2020). https://doi.org/10.1007/s00066-020-01658-0

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