Brachytherapy and dose escalation in de novo stage IVB cervical cancer: a systematic review

This systematic review evaluates the role of brachytherapy and brachytherapy dose escalation in patients with de novo stage IVB cervical cancer (FIGO 2018). Although systemic therapy is the standard treatment, retrospective data suggest that definitive locoregional treatment may improve survival in selected patients, and brachytherapy is the main way to deliver a curative dose to the primary tumor. Its specific contribution beyond external beam radiotherapy and systemic therapy, and the effect of dose escalation in this setting, remain unclear. We searched MEDLINE (PubMed), Embase, Scopus and Cochrane CENTRAL (August 2026) for studies reporting outcomes after brachytherapy-based treatment in de novo stage IVB disease, including comparisons of brachytherapy versus no brachytherapy and of higher versus lower brachytherapy doses. The primary outcome is overall survival; secondary outcomes are progression-free survival, local control and toxicity. Results will be synthesized narratively (SWiM), grouped by comparison, with risk of bias assessed using ROBINS-I. This protocol is registered retrospectively: database searches, study selection and data extraction were completed before registration.