Reporting and Outcomes of Brachytherapy for Gynecologic Re-irradiation: A Systematic Review.

Abstract

Gynecological re-irradiation using brachytherapy (GRIB) represents an important salvage therapy for loco-regionally recurrent gynecologic cancers in previously irradiated patients. This systematic review aimed to evaluate current evidence on GRIB with a focus on reporting practices, identify literature gaps, and propose a framework to optimize future GRIB reporting. A systematic literature search was conducted in PubMed/MEDLINE according to PRISMA guidelines from January 1990 to September 2025. Full English-language publications addressing GRIB were included, excluding case reports, guidelines, reviews, adjuvant GRIB studies, and duplicate publications. Two independent reviewers screened 161 records, with supplementary citation screening identifying additional publications. Reporting patterns were extracted using a template based on the ESTRO/EORTC consensus statement on re-irradiation. 50 original publications including 1,978 patients (71% underwent re-irradiation) were analyzed. Most studies were retrospective (92%) with small sample sizes (mean: 28.2 patients). Modern GRIB techniques demonstrate encouraging local control (35-87% at 1-year, 26-59% at 5-years) and overall survival rates (52-83% at 1-year, 34-54% at 5-years), though accompanied by Grade 3-4 late toxicity rates ranging from 0% to 33%. Significant heterogeneity existed across tumor types, treatment protocols, and reporting practices. Critical parameters including treatment intent, target aims, organ-at-risk constraints, and quality-of-life outcomes were inconsistently or incompletely reported. Radiobiological uncertainties and dose summation challenges further complicate interpretation of published results. GRIB is a reasonable salvage option for selected recurrent gynecologic tumors. Despite advances in image-guided adaptive brachytherapy, the interpretation of available GRIB literature remains challenging due to inconsistent reporting practices, small sample sizes, and heterogeneous treatment protocols. Multi-institutional prospective protocols with standardized reporting, development of dose-summation models, and research addressing radiobiological aspects are essential to generate reliable evidence for guiding future clinical practice.