Patrícia Coelho de Soárez

Effects of 3D image-guided brachytherapy compared to 2D conventional brachytherapy on clinical outcomes in patients with cervical cancer: A systematic review and meta-analyses

To assess the effects of three-dimensional image-guided brachytherapy (3D BT) compared to bi-dimensional BT (2D BT) on clinical outcomes in patients with cervical cancer. We searched PubMed/MEDLINE, EMBASE, Scopus, CENTRAL, Web of Science, and LILACS for studies assessing the effects of 3D BT versus 2D BT on clinical outcomes. Two reviewers independently screened retrieved citations, extracted data and assessed risk of bias from eligible studies. Hazard ratios (HR) were calculated from Kaplan-Meier curves considering the number of events, their timing and the followup of censored patients. We conducted meta-analyses of HR using the inverse-variance random-effects method. Risk Difference (RD) for toxicities were pooled using the Mantel-Haenszel random-effects method. We used the GRADE system to rate the certainty of evidence. Twenty observational studies involving 4287 patients were included. The meta-analyses assessing the effect of 3D BT versus 2D BT on overall survival resulted in a HR of 0.78 (95%CI 0.62-0.98), HR of 0.75 (95%CI 0.62-0.90) for pelvic disease-free survival, HR of 0.93 (95%CI 0.81-1.06) for metastatic disease-free survival, and HR of 0.77 (95%CI 0.59-0.99) for local control. Grade 3-4 global and gastrointestinal toxicities were, respectively, 9% lower (95%CI 6% to 11%) and 5% lower (95%CI 2% to 8%) in patients receiving 3D BT versus 2D BT. Certainty of evidence was very low for all assessed outcomes. Our study may suggest a benefit of 3D BT over conventional 2D BT on important clinical outcomes.

Quality of life of patients submitted to radical radiochemotherapy for cervical cancer: Comparison of outcomes between 2D and 3D image guided brachytherapy

To assess QoL in patients with locally advanced cervical cancer treated with radical radiochemotherapy combined with either 2D or 3D brachytherapy, and to compare outcomes between both techniques. A cross-sectional analytical study was conducted from January 2019 to March 2020. EORTC QLQ-C30 and QLQ-CX24 questionnaires were applied at five time points: before treatment, and 1, 3, 6 and 12 months after treatment. Descriptive statistics, Pearson's chi-square, Fisher's exact test and Bonferroni test were used (p ≤ 0.05). Seventy six out of 82 patients completed all the assessments. The overall mean global health status significantly improved from 63.7 to 72.0 (p = 0.019), with no significant difference between the 2D and 3D brachytherapy groups (69.8 vs. 67.8; p = 0.672). All functional domains of the QLQ-C30 improved over time, including financial difficulties, regardless of the brachytherapy technique. Sexual activity increased significantly (2.5-32.4, p < 0.0001), but also did sexual worry, menopausal symptoms, reduced sexual enjoyment, and vaginal dysfunction. Overall improvement in global health and functioning were observed in patients with locally advanced cervical cancer, regardless of the brachytherapy technique used. Despite improved sexual activity, aspects of sexual dysfunction increased, highlighting the need for comprehensive, multidisciplinary care that includes sexual and psychological support, emphasizing the need for individualized care.