Stereotactic body radiotherapy as an alternative to brachytherapy in cervical cancer (SCORE): A systematic review and meta-analysis
This study evaluates the efficacy and safety of Stereotactic Body Radiotherapy (SBRT) as an alternative to brachytherapy (BCT) for patients with locally advanced cervical cancer (CC) who face barriers such as resource constraints, anatomical challenges, or comorbidities precluding standard treatment. A systematic review and meta-analysis, registered with PROSPERO and adhered to PRISMA standards, was conducted to evaluate SBRT in place of BCT for CC treatment. Eligible studies were systematically sourced from PubMed, Embase, and Cochrane databases. A random-effects model was applied to address study heterogeneity. The analysis focused on outcomes including local control (LC), late gastrointestinal (GI) and genitourinary (GU) toxicity, and overall survival (OS) rates with meta-regression exploring correlations between treatment variables and outcomes. The review analyzed thirteen studies from 2012 to 2024 across diverse regions, with participant ages ranging from 52 to 80 years and sample sizes from 6 to 55 patients. The combined LC rate was 94 % (95 % CI: 91-97 %), and the OS rate was 56 % (95 % CI: 48-63 %), showing no heterogeneity. Late grade ≥ 3 GI and GU toxicity were both 2 %. Meta-regression analysis found no significant associations between treatment parameters and the analyzed outcomes. SBRT is a viable boost therapy for CC patients unable to undergo BCT. It demonstrates strong LC and low levels of severe late toxicity. Further prospective randomized trials are necessary to refine SBRT protocols and confirm long-term outcomes.