Evaluating the feasibility of modern external beam radiotherapy as an alternative approach to brachytherapy in endometrial cancer treatment: A systematic review. | LitMetric
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.
Introduction: Nurses' well-being at work (WAW) is important for overall health care outcomes. Nurses often navigate complex roles, contending with time constraints, ethical challenges and societal undervaluation, underscoring the necessity of addressing their WAW.
Methods: The aim of this systematic review was to analyse the interventions that potentially improve nurses' WAW in care settings for older people.
Background: Laparoscopic sleeve gastrectomy (LSG) specimens are histologically analyzed to identify incidental pathologies. However, no guidelines recommend routine histology. This study evaluates the clinical utility of LSG sample analysis and if incidental diagnoses have a significant clinical impact.
Purpose: To evaluate the diagnostic ability and methodological quality of ML models in detecting Pancreatic Ductal Adenocarcinoma (PDAC) in Contrast CT images.
Method: Included studies assessed adults diagnosed with PDAC, confirmed by histopathology. Metrics of tests were interpreted by ML algorithms.
Objective: Despite certain studies indicating hearing impairments in individuals with polycystic ovary syndrome (PCOS), the correlation between PCOS and sensorineural hearing loss (SNHL) remains inconclusive. This study aimed to investigate the association between PCOS and SNHL.
Data Sources: A systematic literature search was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Library from inception to June 24, 2024.
Polycystic ovary syndrome (PCOS), a major cause of female infertility, affects 4%-20% of reproductive-age women. Metabolic and hormonal alterations are key features of PCOS, potentially raising the risk of endometrial (EC) and ovarian (OVCA) cancers. This systematic review aims to summarise the proposed molecular mechanisms involved in the association between PCOS and EC or OVCA.
