Point-A vs. volume-based brachytherapy for the treatment of cervix cancer: A meta-analysis
Topic: Radiation/Chemotherapy

Background & purpose: To report disease-free survival (DFS) for volume-based and point-A based brachytherapy (BT) in locally advanced cervical cancer.

Materials & methods: We conducted a meta-analysis of studies assessing the effects of point-A and volume-based brachytherapy on 3-year DFS. Studies including stage I-IVA cervical cancer patients were included if standard treatment of concomitant chemo-radiotherapy and high-dose- or pulsed dose rate BT was delivered. The primary outcome was 3-year DFS, and secondary outcomes were 3-year local control (LC), 3-year overall survival (OS) and late toxicity. A random-effects subgroup meta-analysis was done.

Results: In total, 5499 studies were screened, of which 24 studies with 5488 patients were eligible. There was significant heterogeneity among point-A studies (1538 patients) (I2 = 82%, p < 0.05) relative to volume-based studies (3950 patients) (I2 = 58, p = 0.01). The 3-year DFS for point-A and volume-based studies were 67% (95% CI 60%-73%) and 79% (95% CI 76%-82%) respectively (p = 0.001). Three-year LC for point-A and volume-based studies were 86% (95% CI 81%-90%) and 92% (91%-94%) respectively (p = 0.01). The difference in 3-year OS (72% vs. 79%, p = 0.12) was not statistically significant. The proportion of prospectively enrolled patients was 23% for point-A studies and 33% for volume-based studies. There was no difference in late grade 3 or higher gastrointestinal (3% vs. 4%, p = 0.76) genitourinary toxicities (3% vs. 3% p = 0.45) between the two groups.

Conclusion: Volume-based BT results in superior 3-year DFS and 3-year LC. In the absence of randomized trials, this meta-analysis provides the best evidence regarding transition to 3D planning.

Keywords: Brachytherapy; Disease-free survival; Image-guided radiation therapy; Uterine cervical neoplasms.

PICO
Population: Patients with locally advanced cervical cancer
Intervention: Volume-based brachytherapy (BT)
Comparison: Point-A based brachytherapy (BT)
Outcomes: 3-year disease-free survival (DFS), 3-year local control (LC), 3-year overall survival (OS), and late toxicity

Included studies:
title: MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study
title: Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer
title: The promise of image-guided brachytherapy of better clinical outcomes in treatment of cervical cancer: Does it deliver? An Indian scenario
title: MRIguided adaptive radiotherapy in locally advanced cervical cancer from a Nordic perspective
title: A 3-year follow-up study of radiotherapy using computed tomography-based image-guided brachytherapy for cervical cancer
title: Efficacy and toxicity of chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer
title: Radiation therapy for carcinoma of the uterine cervix: comparison of two brachytherapy schedules
title: Impact of brachytherapy technique (2D versus 3D) on outcome following radiotherapy of cervical cancer
title: Toxicity and clinical outcomes with definitive three-dimensional conformal radiotherapy (3DCRT) and concurrent cisplatin chemotherapy in locally advanced cervical carcinoma
title: MRI-guided high-dose-rate intracavitary brachytherapy for treatment of cervical cancer: the University of Pittsburgh experience
title: An early report on outcomes from computed tomographic-based high-dose-rate brachytherapy for locally advanced cervix cancer: A single institution experience
title: 3D CT-based high-dose-rate brachytherapy for cervical cancer: clinical impact on late rectal bleeding and local control
title: Magnetic resonance image-guided brachytherapy for cervical cancer : Prognostic factors for survival
title: Feasibility study of toxicity outcomes using GEC-ESTRO contouring guidelines on CT based instead of MRI-based planning in locally advanced cervical cancer patients
title: Standard chemoradiation and conventional brachytherapy for locally advanced cervical cancer: is it still applicable in the era of magnetic resonance-based brachytherapy?
title: CT based three dimensional dose-volume evaluations for high-dose rate intracavitary brachytherapy for cervical cancer
title: Five years’ experience treating locally advanced cervical cancer with concurrent chemoradiotherapy and high-dose-rate brachytherapy: results from a single institution
title: Evaluation of survival and treatment toxicity with high-dose-rate brachytherapy with cobalt 60 in carcinoma of cervix
title: Long term experience with 3D image guided brachytherapy and clinical outcome in cervical cancer patients
title: Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study
title: The effects of two HDR brachytherapy schedules in locally advanced cervical cancer treated with concurrent chemoradiation: a study from Chiang Mai, Thailand
title: Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women
title: Computed tomography-planned high-dose-rate brachytherapy for treating uterine cervical cancer