Comparison of chronic gastrointestinal and genitourinary toxicities between brachytherapy and external beam radiotherapy for patients with prostate cancer: A systematic review and meta-analysis

BACKGROUND: [Formula: see text] I BT is an effective radiotherapy for prostate cancer. However, comparison data of GI and GU toxicities between BT, BT [Formula: see text] EBRT, and EBRT-alone patient groups is limited. OBJECTIVE: To define the GI and GU toxicities in prostate cancer to prevent adverse events after treatment. METHODS: We searched published studies in PubMed, Cochrane, and Embase databases up to December 31, 2022. The endpoints were the RRs of GI and GU toxicities. Pooled data were assessed using a random-effects model. RESULTS: Fifteen eligible studies were included into this analysis. LDR-BT had significantly lower RRs than LDR-BT [Formula: see text] EBRT for acute GI (2.13; 95% CI, 1.22–3.69; [Formula: see text] 0.007) and late GI toxicities (3.96; 95% CI, 1.23–12.70; [Formula: see text] 0.02). Moreover, EBRT had significantly higher RRs than LDR-BT for acute GU (2.32; 95% CI, 1.29–4.15; [Formula: see text] 0.005) and late GU toxicities (2.38; 95% CI, 1.27–4.44; [Formula: see text] 0.007). HDR-BT had significantly higher RRs for acute GU toxicities than LDR-BT alone (0.30; 95% CI, 0.23–0.40; [Formula: see text] 0.00001). CONCLUSION: The results implied that BT with and without EBRT can result in both GI and GU toxicities in patients with prostate cancer, with LDR-BT leading to a poorer urinary function than EBRT.