title: High-dose-rate vs. low-dose-rate intracavitary brachytherapy for carcinoma of the uterine cervix: Systematic review and meta-analysis.
abstract: OBJECTIVE
  We performed a meta-analysis to compare the treatment outcomes between high-dose-rate (HDR) and low-dose-rate (LDR) intracavitary brachytherapy (ICBT) for the treatment of cervical cancer.
  
  
  METHODS
  We searched the PubMed database for articles and the related referenced articles that compared HDR-ICBT and LDR-ICBT. A total of 15 published articles, 3 prospective randomized trials, and 12 retrospective studies performed between 1966 and December 2013 were selected using predefined inclusion and exclusion criteria for each study. The effect sizes were obtained from the odds ratios of the 5-year overall survival, 5-year disease-free survival (DFS), pelvic (locoregional) recurrence, and rectal and bladder complication rates in each study. The common effect sizes and 95% confidence intervals (CIs) were calculated using either the fixed or the random-effect model, according to the results of the homogeneity tests.
  
  
  RESULTS
  We analyzed the outcome data for 18,937 patients, including 10,807 patients in the HDR-ICBT treatment group and 8,130 patients in the LDR-ICBT group. The common effect sizes (95% CI) for the 5-year survival rate, 5-year DFS rate, and pelvic recurrence rate were 1.1350 (0.9231-1.3955), 1.0777 (0.4896-2.3720), and 0.9521 (0.7624-1.1890), respectively. The common effect sizes (95% CI) for moderate-to-severe complication rates of the rectum and the bladder were 0.7645 (0.5099-1.1463) and 0.9051 (0.6140-1.3342), respectively. There were no significant differences between HDR- and LDR-ICBT considering the 5-year survival, 5-year DFS, pelvic recurrence, and the rectal and bladder complication rates.
  
  
  CONCLUSIONS
  The treatment outcome after HDR-ICBT seems to be equivalent to that following LDR-ICBT in terms of survival, pelvic recurrence, and major complications.
authors.affiliation: Department of Radiation Oncology, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Kang Kyoo
authors.initials: KK
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Institute of Basic Medical Science, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung Mo
authors.initials: JM
authors.lastname: Nam
authors.affiliation: Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Chun Bae
authors.initials: CB
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Ewha Womans University Medical Center, Seoul, Korea. Electronic address: krparkia@gmail.com.
authors.forename: Kyung Ran
authors.initials: KR
authors.lastname: Park
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002985:Clinical Protocols; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D058958:Organs at Risk / Q000528:radiation effects; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D012007:Rectum / Q000528:radiation effects; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
keywords: Carcinoma of the uterine cervix; High-dose-rate; Intracavitary brachytherapy; Low-dose-rate; Meta-analysis