Comparison of chronic gastrointestinal and genitourinary toxicities between brachytherapy and external beam radiotherapy for patients with prostate cancer: A systematic review and meta-analysis
Topic: Radiation/Chemotherapy

Background: 125I BT is an effective radiotherapy for prostate cancer. However, comparison data of GI and GU toxicities between BT, BT + EBRT, and EBRT-alone patient groups is limited.

Objective: To define the GI and GU toxicities in prostate cancer to prevent adverse events after treatment.

Methods: We searched published studies in PubMed, Cochrane, and Embase databases up to December 31, 2022. The endpoints were the RRs of GI and GU toxicities. Pooled data were assessed using a random-effects model.

Results: Fifteen eligible studies were included into this analysis. LDR-BT had significantly lower RRs than LDR-BT + EBRT for acute GI (2.13; 95% CI, 1.22-3.69; P= 0.007) and late GI toxicities (3.96; 95% CI, 1.23-12.70; P= 0.02). Moreover, EBRT had significantly higher RRs than LDR-BT for acute GU (2.32; 95% CI, 1.29-4.15; P= 0.005) and late GU toxicities (2.38; 95% CI, 1.27-4.44; P= 0.007). HDR-BT had significantly higher RRs for acute GU toxicities than LDR-BT alone (0.30; 95% CI, 0.23-0.40; P< 0.00001).

Conclusion: The results implied that BT with and without EBRT can result in both GI and GU toxicities in patients with prostate cancer, with LDR-BT leading to a poorer urinary function than EBRT.

Keywords: Prostate cancer; brachytherapy; external beam radiotherapy; gastrointestinal;

PICO
Population: Patients with prostate cancer
Intervention: Brachytherapy (BT), specifically 125I BT, Low Dose Rate Brachytherapy (LDR-BT), and High Dose Rate Brachytherapy (HDR-BT)
Comparison: External Beam Radiotherapy (EBRT) alone, and the combination of Brachytherapy (BT) + External Beam Radiotherapy (EBRT)
Outcomes: Chronic gastrointestinal (GI) and genitourinary (GU) toxicities

Included studies:
title: Predictive factors of rectal hemorrhage in patients with localized prostate cancer who underwent low-dose-rate brachytherapy
title: Treatment of low-risk prostate cancer: A retrospective study with 477 patients comparing external beam radiotherapy and I-125 seeds brachytherapy in terms of biochemical control and late side effects
title: Genitourinary toxicity after permanent iodine-125 seed implantation: The nationwide Japanese prostate cancer outcome study of permanent iodine-125 seed implantation (J-POPS)
title: Predictive factors of long-term rectal toxicity following permanent iodine-125 prostate brachytherapy with or without supplemental external beam radiation therapy in 2216 patients
title: High-dose-rate brachytherapy monotherapy versus low-dose-rate brachytherapy with or without external beam radiotherapy for clinically localized prostate cancer
title: Clinical outcomes of 125I brachytherapy with and without external-beam radiation therapy for localized prostate cancer: Results from 300 patients at a single institution in Japan
title: Predictive factors of rectal toxicity after permanent iodine-125 seed implantation: Prospective cohort study in 2339 patients
title: Acute and late toxicities in localized prostate cancer patients treated with low-dose I brachytherapy (110 Gy) in combination with external beam radiation therapy versus brachytherapy alone (160 Gy)
title: Urinary and Rectal Toxicity Profiles After Permanent Iodine-125 Implant Brachytherapy in Japanese Men: Nationwide J-POPS Multi-institutional Prospective Cohort Study
title: Comparison of genitourinary and gastrointestinal toxicity among four radiotherapy modalities for prostate cancer: Conventional radiotherapy, intensity-modulated radiotherapy, and permanent iodine-125 implantation with or without external beam radiotherapy
title: Periodical assessment of genitourinary and gastrointestinal toxicity in patients who underwent prostate low-dose-rate brachytherapy
title: Late rectal toxicity after prostate brachytherapy: Influence of supplemental external beam radiation on dose-volume histogram analysis
title: Comparison of acute and subacute genitourinary and gastrointestinal adverse events of radiotherapy for prostate cancer using intensity-modulated radiation therapy, three-dimensional conformal radiation therapy, permanent implant brachytherapy and high-dose-rate brachytherapy
title: Combined brachytherapy with external beam radiotherapy for localized prostate cancer: Reduced morbidity with an intraoperative brachytherapy planning technique and supplemental intensity-modulated radiation therapy
title: A comparison of acute and chronic toxicity for men with low-risk prostate cancer treated with intensity-modulated radiation therapy or (125)I permanent implant