Abstract
PURPOSE: This study evaluates the efficacy, toxicity, and survival impact of high-dose-rate endorectal brachytherapy (HDR-EBT) as neoadjuvant therapy for locally advanced rectal cancer. METHODS: A review of 16 studies from PubMed, Embase, and Web of Science (1990-2023) was conducted. RESULTS: Patients treated with HDR-EBT alone had a pathological complete response (pCR) rate of 23.7%-35.3% (mean: 24.3%), anal preservation rate of 12.2%-74.9% (mean: 41.8%), and 5-year progression-free survival rate of 64.6%-65.4% (mean: 65.3%). When combined with concurrent long-term radiotherapy and chemotherapy, pCR rates improved from 18.1%-55.0% (mean: 31.0%), with anal preservation rates of 39.6%-51.4% (mean: 45.3%). However, overall survival did not significantly improve. CONCLUSION: Integrating advanced techniques such as intensity-modulated radiation therapy (IMRT) with HDR-EBT shows promise. This approach particularly benefits patients ineligible for surgery or those adopting a watch-and-wait strategy after complete clinical remission, thus highlighting the potential of HDR-EBT in this treatment landscape.