High-dose rate and low-dose rate intracavitary brachytherapy for cervical carcinoma: A systematic review / 肿瘤

ABSTRACT

Objective: To assess the clinical effectiveness and safety of high-dose rate (HDR) and low-dose rate (LDR) intracavitary brachytherapy for cervical carcinoma. Methods: This study retrieved relevant randomized and quasi-randomized control trial in PubMed (1966 to December 2007), EMBASE (1974 to December 2007), Cochrane Library (Issue 4, 2007), Chinese Biomedical Literature Database (CBM, 1978 to December 2007), China Journal Full Text Database (CJFD, 1994 to December 2007), and Chinese Scientific Journals Full Text Database (CSJD, 1989 to December 2007). We also traced back the references to collect the relevant trails. Inclusion criteria were as follows randomized or quasi-randomized controlled trails reported in English or Chinese; high- or low-dose rate intracavitary brachytherapy in the treatment of local advanced cervical carcinoma. Two reviewers assessed the quality of included trials and extracted data independently. The RevMan 4. 2. 10 software was used for Meta-analysis. Results: Four studies were involved and 1 253 patients were included. Meta-analysis showed that there was no significant difference in 3-, 5-, 10-year overall survival rate, 3- and 5-year pelvic control rate, 3-, 5-, and 10-year relapse-free survival rate between HDR group and LDR group. The pooled relative risk value and 95% CI were 0.96 (0.80-1.16), 0.92 (0.83-1.01), 0.86 (0.70-1.05); 0.96 (0.86-1.07),0.95 (0.87-1.05); 1.02 (0.84-1.23), 0.98 (0.89-1.07), and 1.02 (0.88-1.19), respectively. There was no significant difference in local-regional recurrence, local recurrence with distant metastasis, para-aortic lymph node metastasis, and distant metastasis between the two groups. The relative risk value and 95% CI were 1.03 (0.83-1.30), 2.23 (0.78-6.34), 1.06 (0.50-2.24), and 1.00 (0.76-1.32) respectively. The 3-5 grade complications in the bladder, rectosigmoid colon, and small intestine had no statistical difference between the two groups. The relative risk value and 95% CI were 1.08 (0.18-6.63), 0.90 (0.25-3.21), and 3.12 (0.96-10.15), respectively. Conclusion: This study suggests that HDR has similar effects with LDR in improving the survival rate and tumor control rate of patients with cervical carcinoma. Because of the small number and uneven qualities of samples, the conclusion needs further verification by large sample, multi-center, randomized controlled trials.