Evaluating the feasibility of modern external beam radiotherapy as an alternative approach to brachytherapy in endometrial cancer treatment: A systematic review

Martina Ferioli; Gabriella Macchia; Savino Cilla; Claudio Malizia; Anna Myriam Perrone; Luca Tagliaferri; Milly Buwenge; Francesco Deodato; Erika Galietta; Costanza M. Donati; Arina A. Zamfir; Lidia Strigari; Silvia Cammelli; Pierandrea De Iaco; Alessio G. Morganti

doi:10.5114/jcb.2024.145274

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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abstract:

Review paper

Evaluating the feasibility of modern external beam radiotherapy as an alternative approach to brachytherapy in endometrial cancer treatment: A systematic review

Martina Ferioli

^{1, 2}

,

Gabriella Macchia

³

,

Savino Cilla

⁴

,

Claudio Malizia

⁵

,

Anna Myriam Perrone

⁶

,

Luca Tagliaferri

⁷

,

Milly Buwenge

¹

,

Francesco Deodato

³

,

Erika Galietta

¹

,

Costanza M. Donati

^{1, 8}

,

Arina A. Zamfir

⁸

,

Lidia Strigari

⁹

,

Silvia Cammelli

^{1, 8}

,

Pierandrea De Iaco

⁶

,

Alessio G. Morganti

^{1, 8}

Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
Radiation Oncology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Campobasso, Italy
Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Oncologic Gynecology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

J Contemp Brachytherapy 2024; 16, 5: 383–389

DOI: https://doi.org/10.5114/jcb.2024.145274

Online publish date: 2024/11/14

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AMA

Ferioli M, Macchia G, Cilla S, et al. Evaluating the feasibility of modern external beam radiotherapy as an alternative approach to brachytherapy in endometrial cancer treatment: A systematic review. Journal of Contemporary Brachytherapy. 2024;16(5):383-389. doi:10.5114/jcb.2024.145274.

APA

Ferioli, M., Macchia, G., Cilla, S., Malizia, C., Perrone, A.,  & Tagliaferri, L. et al. (2024). Evaluating the feasibility of modern external beam radiotherapy as an alternative approach to brachytherapy in endometrial cancer treatment: A systematic review. Journal of Contemporary Brachytherapy, 16(5), 383-389. https://doi.org/10.5114/jcb.2024.145274

Chicago

Ferioli, Martina, Gabriella Macchia, Savino Cilla, Claudio Malizia, Anna Myriam Perrone, Luca Tagliaferri,  and Milly Buwenge et al. 2024. "Evaluating the feasibility of modern external beam radiotherapy as an alternative approach to brachytherapy in endometrial cancer treatment: A systematic review". Journal of Contemporary Brachytherapy 16 (5): 383-389. doi:10.5114/jcb.2024.145274.

Harvard

Ferioli, M., Macchia, G., Cilla, S., Malizia, C., Perrone, A., Tagliaferri, L., Buwenge, M., Deodato, F., Galietta, E., Donati, C., Zamfir, A., Strigari, L., Cammelli, S., De Iaco, P.,  and Morganti, A. (2024). Evaluating the feasibility of modern external beam radiotherapy as an alternative approach to brachytherapy in endometrial cancer treatment: A systematic review. Journal of Contemporary Brachytherapy, 16(5), pp.383-389. https://doi.org/10.5114/jcb.2024.145274

MLA

Ferioli, Martina et al. "Evaluating the feasibility of modern external beam radiotherapy as an alternative approach to brachytherapy in endometrial cancer treatment: A systematic review." Journal of Contemporary Brachytherapy, vol. 16, no. 5, 2024, pp. 383-389. doi:10.5114/jcb.2024.145274.

Vancouver

Ferioli M, Macchia G, Cilla S, Malizia C, Perrone A, Tagliaferri L et al. Evaluating the feasibility of modern external beam radiotherapy as an alternative approach to brachytherapy in endometrial cancer treatment: A systematic review. Journal of Contemporary Brachytherapy. 2024;16(5):383-389. doi:10.5114/jcb.2024.145274.

Purpose:
This systematic review aimed to assess the feasibility, safety, and efficacy of using modern external beam radiotherapy (EBRT) techniques, such as intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic body radiotherapy (SBRT) as alternative approaches to brachytherapy (BRT) in adjuvant treatment of endometrial cancer (EC).

Material and methods:
A systematic review was conducted following PRISMA guidelines. The research question was framed using the PICO method, focusing on patients with EC [P] and comparing modern EBRT techniques (IMRT, VMAT, SBRT) [I] vs. BRT [C], to evaluate their feasibility, safety, and effectiveness, particularly in terms of tumor local control (LC) [O]. Both planning and clinical outcomes, including acute toxicity, late side effects, and LC were analyzed with quality assessments performed using the GRADE framework and ROBINS-I tool.

Results:
Planning studies revealed that while IMRT and VMAT provided comparable or improved target coverage and dose homogeneity compared with BRT, brachytherapy was associated with lower doses to critical organs. Post-operative SBRT and SIB-VMAT studies reported high LC rates (up to 100%) with minimal acute toxicity. However, the overall quality of evidence was low to very low, with significant risks of bias, mainly related to participant selection.

Conclusions:
This review highlights that, although modern EBRT techniques, such as IMRT and VMAT are feasible alternative approaches to BRT for post-operative vaginal cuff irradiation, the current evidence does not support their superiority over BRT. Brachytherapy remains a highly effective treatment modality with well-established benefits. Future research should focus on more robust comparisons between EBRT and BRT, considering not only local control and toxicity, but also psychological impact and quality of life, especially in low-resource settings, where access to BRT may be limited.

keywords:

endometrial cancer, brachytherapy, external beam radiotherapy (EBRT), intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic body radiotherapy (SBRT)