Abstract
ObjectiveTo compare the efficacy and safety of high dose rate (HDR) and low dose rate (LDR) brachytherapy in treating early-stage oral cancer.Data SourcesA systematic search of MEDLINE, EMBASE and Cochrane Library databases, restricted to English language up to June 1, 2012, was performed to identify potentially relevant studies.Study SelectionOnly randomized controlled trials (RCT) and controlled trials that compared HDR to LDR brachytherapy in treatment of early-stage oral cancer (stages I, II and III) were of interest.Data Extraction and SynthesisTwo investigators independently extracted data from retrieved studies and controversies were solved by discussion. Meta-analysis was performed using RevMan 5.1. One RCT and five controlled trials (607 patients: 447 for LDR and 160 for HDR) met the inclusion criteria. The odds ratio showed no statistically significant difference between LDR group and HDR group in terms of local recurrence (OR = 1.12, CI 95% 0.62–2.01), overall mortality (OR = 1.01, CI 95% 0.61–1.66) and Grade 3/4 complications (OR = 0.86, CI 95% 0.52–1.42).ConclusionsThis meta-analysis indicated that HDR brachytherapy was a comparable alternative to LDR brachytherapy in treatment of oral cancer. HDR brachytherapy might become a routine choice for early-stage oral cancer in the future.
Highlights
Oral cancer is posing an ever increasing threat to global health
This meta-analysis indicated that high dose rate (HDR) brachytherapy was a comparable alternative to Low dose rate (LDR) brachytherapy in treatment of oral cancer
HDR brachytherapy might become a routine choice for early-stage oral cancer in the future
Summary
Oral cancer is posing an ever increasing threat to global health. The annual case number is estimated around 275,000, two-thirds of which occur in developing countries [1], [2]. Owing to its excellent local control rates, acceptable side effects, and high quality of life, brachytherapy has been demonstrated as a sole treatment modality or a supplementary method for oral cancer. It provides a high localized dose of radiation, with rapid fall-off and short overall treatment duration [4]. Low dose rate (LDR) brachytherapy has been reported with a superior outcome in treatment of carcinoma of the lip, tongue, floor of mouth, oral mucosa, base of tongue, buccal mucosa, soft palate, etc. LDR brachytherapy is challenged by high dose rate (HDR) brachytherapy, as the latter shows advantages in avoiding radiation exposure to medical personnel and shortening the treatment period. The efficacy and safety of HDR brachytherapy, compared with LDR brachytherapy, remains controversial
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