Benefits and drawbacks of specific approaches:
Combined EBRT/Brachytherapy
External beam radiotherapy (EBRT) and brachytherapy have complimentary strengths, such that applying them together theoretically improves the outcome, by combining the central power of brachytherapy, with the better margin coverage of EBRT. Very high disease-free survival results have been published with combined modality therapy (13), even in patients with more advanced disease (14).
Against the demonstrated high efficacy of this approach are several drawbacks. First, studies that have compared the outcome of combined therapy versus brachytherapy monotherapy in early to intermediate prognosis patients have failed to demonstrate superiority in the combined therapy arm (23).
Combined therapy regimens may also be more toxic than monotherapy approaches (24). Finally, combined therapy is expensive.
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