Preoperative brachytherapy for early-stage cervical cancer: Systematic review and meta-analysis

Objective. To assess the rate of pathological response rate, and the oncological outcomes of preoperative brachytherapy (PBT) in early-stage cervical cancer.Methods. A systematic literature review was conducted according to the Preferred Reporting Items for Sys-tematic Reviews and meta-analyses (PRISMA) statement. MEDLINE, Embase, Cochrane Central Register of Con-trolled Trials, and Scopus databases were searched from inception until April 2022. Only English and French articles were included. Studies containing data about pathology response or oncological outcomes among pa-tients who received PBT as compared to those who underwent up-front surgery in early-stage cervical cancer were included. This study was registered in PROSPERO (CRD42022319036).Results. Thirteen studies met the inclusion criteria, 3 randomized controlled trials (RCT), and 10 non-random-ized studies (NRS). The 5-year survival was significantly higher in the PBT group compared with the up-front sur-gery group (OR 1.78, 95% CI 1.11-2.84, I2 = 0%) in the NRS. Recurrence rate was significantly lower in the PBT group compared with in up-front surgery group in the analysis of the RCT but not in NRS, (OR 0.34, 95% CI 0.13-0.91, I2 not applicable) and (OR 0.72, 95% CI 0.26-1.95, I2 = 51%) respectively. PBT was associated with a statistically significant lower rate of positive margins (OR 0.28, 95% CI 0.09-0.89; I2 = 42%) in the RCT and with a significantly higher rate of complete pathology response (CPR) in the RCT analysis (OR 2.55, 95% CI 1.11-5.85, I2 = 0%) and in the NRS (OR 9.64, 95% CI 1.88-49.48, I2 = 76%) compared with the up-front surgery group. Conclusion. Preoperative brachytherapy in patients with early-stage cervical cancer could improve pathologic and oncologic outcomes, but it should be assessed in high-quality randomized controlled trials before its imple-mentation in clinical practice.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study evaluated the efficacy of preoperative brachytherapy (PBT) in early-stage cervical cancer and found that PBT can improve pathological and oncological outcomes. However, further assessment in high-quality randomized controlled trials is needed before its implementation in clinical practice.