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Advances in Radiotherapy
& Nuclear Medicine Brachytherapy versus external beam in local dose escalation

Table 4. (Continued)
Authors Study n pts Treatment boost Target coverage Dose to OAR Main results
Sharma Retr 12 IRT vs. IMRT IRT: IRT: Target coverage was
et al. 25 PTV D95 57.16 (±5.54) Dmax EQD2 rectum, 54.64 (±3.57); significantly better with IRT
IMRT: Dmax EQD2 bladder, 50.64 (±7.2) than with IMRT ( P=0.003).
PTV D95 41.47 (±1.79) IMRT: IMRT delivered
Dmax EQD2 rectum, 62.63 (±3.94); significantly higher doses
Dmax EQD2 bladder; 66.31 (±2.79) to the rectum ( P=0.02) and
bladder ( P=0.004)
Gielda Retr 4 IRT vs. HT IRT: IRT: Tomotherapy delivered
et al. 3 PTV EQD2 D90 87 Mean rectum, D2cc 4.17; higher doses to the femoral
HT: Mean sigmoid, D2cc 2.70; heads (mean 1.23 Gy per
PTV EQD2 D90 87 Mean bladder, D2cc 4.70 fraction) and bowel
HT:
Mean rectum, D2cc 3.80;
Mean sigmoid, D2cc 2.43;
Mean bladder, D2cc 4.43
Shwetha Retr 10 IRT vs. IMRT HDR-IRT: HDR-IRT: The integral dose to the
et al. 4 D95% 103.74±0.17; D1cc bladder 81.00±23.29; PTV was significantly
IMRT_SW: IMRT_SW: higher with HDR-IRT
D95% 104.63±3.83; D1cc bladder 88.68±15.66; compared to IMRT
STATIC_5: STATIC_5: The integral doses to the
D95% 104.69±4.49; D1cc bladder 91.71±17.08; OAR were smaller with
STATIC_10: STATIC_10: HDR-IRT as compared to
D95% 105.43±3.62; D1cc bladder 90.03±16.08; IMRT
STATIC_20: STATIC_20:
D95% 105.03±4.15 D1cc bladder 89.59±16.09;
p<0.0001 HDR-IRT:
D1cc rectum 77.43±17.1;
IMRT_SW:
D1cc rectum 87.67±12.64;
STATIC_5:
D1cc rectum 89.58±11.64;
STATIC_10:
D1cc rectum 89.18±13.37;
STATIC_20:
D1cc rectum 88.75±12.85;
p<0.0001*
Abbreviations: CK: CyberKnife; CTV HR: Clinical target volume high risk; CTV IR: Clinical target volume intermediate risk; EBRT: external beam
radiotherapy; fr: fractions; FU: follow-up; GTV: Gross tumor volume; Gy: gray; HDR: High-dose rate; HT: Helical tomotherapy;
IMPT: Intensity-modulated proton beam therapy; IMRT: Intensity-modulated radiotherapy; IRT: Interventional radiotherapy; N: numbers; n.a.: not
avaible; OAR: Organs at risk; pts: patients; PTV: Planning target volume; Retr: retrospective; SRT: Stereotactic radiotherapy; SW: Sliding-window;
y: Years, vs.: Versus.

or last follow-up. Only studies with a minimum follow-up randomized controlled trials, the initial certainty rating
of 6 months were included to ensure sufficient observation was classified as high, with potential downgrading applied
time for the assessment of late treatment effects. if concerns are identified in any of the evaluated domains.
The overall certainty of evidence was categorized as high,
2.6. Study risk of bias assessment moderate, low, or very low.
The GRADEpro Guideline Development Tool (GDT) Each included study underwent an independent risk of
was employed to generate Summary of Findings tables in bias assessment by two reviewers, who provided detailed
accordance with Cochrane systematic review standards. justifications and supporting evidence for their judgments
The certainty of evidence for each outcome was evaluated across relevant domains (classified as low risk, high risk,
using the GRADE approach, which considers potential or some concerns). Discrepancies were resolved through
limitations such as publication bias, methodological discussion; if consensus could not be reached, a third
flaws, imprecision, indirectness, and inconsistency. For reviewer served as an adjudicator.

Volume 3 Issue 3 (2025) 20 doi: 10.36922/ARNM025160017