Clinical and pathological outcomes of brachytherapy application for the treatment of high-grade vaginal squamous intraepithelial lesions: a systematic review.

Authors

Carlos Felipe Durán Méndez, Juan Carlos Mendieta Redondo, Juan Sebastián Obando Rodríguez, Emmanuel Sánchez Díaz, Jonathan Peralta-Jiménez, Santiago Vieira-Serna, Carolina Morante-Caicedo, Núria Agustí, Santiago Ardila Giraldo, John Edwin Feliciano-Alfonso, Juliana Rodríguez, René Pareja

Published in

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. Pages 104876. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

To evaluate the efficacy and safety of intracavitary brachytherapy for high-grade vaginal squamous intraepithelial lesions (HSIL/VaIN2-3) and clarify its role and dose-fractionation within the therapeutic algorithm.
We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-compliant systematic review registered in International Prospective Register of Systematic Reviews (CRD420261292798). MEDLINE, Embase, and CENTRAL were searched from inception to February 2026 for clinical trials, analytical observational studies, and case series that included at least 5 women with biopsy-proven HSIL/VaIN2-3 treated with any brachytherapy modality. Two reviewers independently screened records, selected studies, and extracted data on local control, persistence, recurrence, progression to invasive cancer, and acute and late toxicity; methodological quality was appraised with the Joanna Briggs Institute case-series checklist.
Ten retrospective series comprising 225 women with vaginal intraepithelial neoplasia (214 HSIL/VaIN2-3) treated with low-, medium-, or high-dose-rate intracavitary brachytherapy were included. Median age ranged from 56 to 63 years, and follow-up duration from 26 to 127 months; most patients had prior cervical intraepithelial neoplasia, cervical or endometrial cancer, hysterectomy, or previous local treatments. Across studies, actuarial or crude local control ranged from 85% to 95%; 6 of 225 patients (2.7%) had persistent disease, 3 of 176 patients with vaginal intraepithelial neoplasia-specific data (1.7%) recurred, and 5 of 225 (2.2%) progressed to invasive or microinvasive vaginal carcinoma, usually within 2 to 3 years. Acute toxicity was predominantly grade 1 or 2 urinary, gynecologic, or anorectal and self-limited, whereas relevant late morbidity was mainly vaginal; severe rectal or bladder events were uncommon, but late grade ≥3 vaginal stenosis or ulceration increased at higher equivalent doses.
Intracavitary brachytherapy achieves high local control with low persistence, recurrence, and progression rates in women with HSIL/VaIN2-3, particularly with contemporary high-dose-rate regimens around 45 to 55 Gy Equivalent dose in 2Gy fractions (EQD₂) at 3 to 5 mm depth. Given the small, noncomparative, methodologically heterogeneous series and the apparent rise in late vaginal toxicity beyond EQD₂ ≈70 Gy, brachytherapy should be reserved for carefully selected extensive, multifocal, recurrent, post-hysterectomy, or surgically high-risk cases, and future prospective multicenter studies comparing brachytherapy with surgery, laser, and topical treatments and incorporating standardized dosimetry and patient-reported outcomes are warranted.

PMID:
42580935
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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