NICE summary of review conclusions
The evidence from the systematic review of clinical trials suggests that high dose rate intracavity brachytherapy is comparable with low dose rate brachytherapy in improving tumour control and survival rates for women with cervical carcinoma. The incidence of small bowel complications was slightly higher with high dose rate intracavity brachytherapy but the disadvantage of this complication may be outweighed by the advantages of high dose rate brachytherapy, which include outpatient treatment, patient convenience, accuracy of treatment, individualised treatment and complete radiation protection for personnel.
Replacing the use of low dose rate intracavity brachytherapy with high dose rate treatment in patients with cervical cancer will improve patient care by reducing use of a less convenient and frequently uncomfortable therapy and replacing it with an equally efficacious and more acceptable alternative for the patient.
The Implications for practice section of the Cochrane review stated:
Due to some potential advantages of high dose rate intracavity brachytherapy, such as rigid immobilisation, outpatient treatment, patient convenience, accuracy of source and applicator positioning, individualised treatment with source optimisation and complete radiation protection for personnel, high dose rate intracavity brachytherapy should be considered a standard treatment strategy for patients with cervical cancer instead of low dose rate intracavity brachytherapy, especially in developing countries.
This review included the current available evidence and showed that high dose rate intracavity brachytherapy was comparable with low dose rate intracavity brachytherapy. In the subgroup analysis there was no significant difference between high dose rate and low dose rate when considering overall survival, disease specific survival, relapse-free survival, local control rate, recurrence and metastasis and treatment related to complications for patients with clinical stages I, II and III. Therefore, we recommend the use of high dose rate intracavity brachytherapy for all clinical stages of uterine cervix cancer.