“” (Table 2) Table 2 Strength of recommendations and implication to quality of evidence. Recommendation or statement Description in GRADE

approach Interpretation Strong recommendation We selleckchem recommend (should) 1. Most individuals should receive the intervention, assuming that they have been informed about and have understood its benefits, harms and burden.     2. The recommendation could unequivocally be used for policy making. Weak recommendation We suggest (might) 1. Uncertainty about the relative importance of the benefits and downsides to those affected, or differences in how important they are to different people, which could affect the balance between the benefits versus harms and burden     2. Doubt about the recommendation could be use for policy making We chose a commonly used method for detecting publication bias, which is a graphical plot of estimates of the odds ratios from the individual studies versus the inverse of their variances, which is commonly referred to as a “”funnel plot.”" The analyses were performed using comprehensive meta-analysis software (Revman 5.0). Results The two trial assessors agreed on the selection of five RCTs. The Quorum flow diagram illustrates the main reasons

selleck for trial exclusion (Figure 1). The overall sample included 2,145 patients in 5 RCTs comparing LDR to HDR [22–26]. The published studies are described in Table 3 and the quality of studies is described in Figure 2 and Figure 3 Figure 1 Flowchart according to QUOROM statement criteria, informing the reason of some trials to be excluded. Resminostat Figure 2 Summary of findings (SoF) table using GRADE methodology for overall mortality. Figure 3 Summary of findings (SoF) table using GRADE methodology for local recurrence. Table 3 Characteristics of clinical trials Year Study Patients Fraction of LDR (Gy/fraction) Fraction of HDR (Gy/Fraction) Pelvic RT Dose (Gy) Clinical stage             LDR HDR 2004 Lertsanguansinchai 237 25–35/2 15–16.6/2 40–50 IB-5 IB-7             IIA-2 IIA-1             IIB-61 IIB-64             IIIB-41 IIIB-40 2002 Hareyama 132 IIA-50/4 IIA-29,5/4 30–40 II-26 II-22       IIB-40/3 IIB-23,3/3 or 4   III-39 III-45       III-30/3 III-17,3/3

or 2       1993 Teshima 430 I-56/2 I-28/4 16–20 I-28 I-32       II-57/2 II-30/4   II-61 II-80       III-58/2 III-29/3   III-82 III-147 1994 Patel 482 I-II>3 cm-75/2 I-II>3 cm-38/2 35–40 I-39 I-35       I-II<3 cm-35/1 I-II<3 cm-18/2   II-93 II-90       III-35/1 III-18/2   III-114 III-111 2006 Shrivastava 800 I and II-60/2 I and II-35/5 40/20 I II-200 I II-200       III-30/1 III-21/3   III-200 III-200 Methodological quality of included studies Following the GRADE system, the study design for all trials included in the review of evidence for HDR and LDR was randomized controlled trial, which is scored as a high type of evidence. As requested from the methodology of GRADE, study quality was also assessed by reviewing whether the studies had limitations or flaws.