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).
Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea (Republic of).
Strahlenther Onkol. 2020 Nov;196(11):973-982. doi: 10.1007/s00066-020-01658-0. Epub 2020 Jul 6.
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.
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.
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).
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.
对近距离放疗（BT）技术（二维[2D]或三维图像引导[3D]）对宫颈癌患者结局的影响进行系统评价和荟萃分析。
检索 PubMed 和 EMBASE 数据库，截至 2019 年 4 月 16 日，以评估 3D-BT 与 2D-BT 相比在宫颈癌中的疗效的研究。终点包括严重毒性的累积发生率、局部区域无复发生存（LRRFS）、无进展生存（PFS）和总生存（OS）。使用随机效应模型对荟萃分析中的风险比（HR）进行汇总。
纳入了定量综合的六项研究中的八项队列。五项研究中的三个队列评估了毒性方面的汇总 HR，3D-BT 与 2D-BT 相比的 HR 为 0.54（95%置信区间[CI] 0.37-0.77）。所有六项研究均被纳入 LRRFS 的综合研究，3D-BT 更有利（HR=0.61[95%CI 0.40-0.93]）。三项研究被纳入 PFS 的分析，3D-BT 优于 2D-BT（HR=0.75[95%CI 0.59-0.96]）。五项研究被纳入 OS 的汇总 HR，3D-BT 与 2D-BT 相比的汇总 HR 为 0.65（95%CI 0.40-1.06）。
3D-BT 可能降低宫颈癌患者的严重毒性，并改善 LRRFS 和 PFS。3D-BT 应被视为宫颈癌标准治疗管理的一部分，应努力在韩国采用该程序。
