Summary

Introduction: Brachytherapy (BT) is a type of radiation therapy, which consists of placing a radioactive source directly in or close to the tumour, by the insertion of guide needles, rods, probes and radioactive wires or the implantation of "seeds". High-doserate brachytherapy (HDR-BT) makes use of a radioactive substance that releases a large
amount of radiation in a short time, generally high-dose-rate iridium-192, which has very little volume and so enables very fine tubes to be automatically introduced and controlled from a computer. Unlike low-dose-rate brachytherapy (LDR-BT), its administration does not require the patient to be immobilised and isolated for long time periods; moreover, irradiation of healthcare staff during the introduction of radioactive isotopes is avoided.

Objectives: The principal aim of this report was to assess the effectiveness and safety of high-dose-rate brachytherapy in treatment of tumours of the head and neck. The specific objectives were twofold:

 1) to assess the benefits in terms of loco-regional control, distant metastasis, survival, safety, and costs with respect to conventional
treatments (external radiotherapy, surgical excision, chemotherapy and low rate brachytherapy)

 2) to assess the benefits with respect to new treatment modalities
(intensity modulated radiation therapy, stereotactic radiotherapy, etc.).

Methods: In April 2012, we conducted a systematic search, with no time limit, of the scientific literature contained: in the leading computerised biomedical databases, namely, PubMed, Embase, ISI Web of Knowledge, Centre for Reviews and Recommendations, Cochrane, etc.; and in databases of ongoing studies (ClinicalTrials.gov, Current Controlled Trials, etc) and clinical practice guidelines (National Guideline Clearinghouse, Scottish Collegiate Guideline Network, etc.). In addition, a general Internet search was made to locate grey literature. Papers were selected on the basis of pre-established inclusion criteria, excluding, among others, studies that jointly assessed different brachytherapy techniques and those that had fewer than 50 patients. The data were collected and summarised in evidence tables,
with quality being assessed using the SIGN scale.

Results, discussion, conclusions and recomendations see pdf below