Brachytherapy-Integrated Hyperthermia for Pelvic Malignancies: Clinical Evidence, Technical Platforms, Thermal Dosimetry, and Translational Barriers

Abstract

Simple Summary Hyperthermia may increase radiation sensitivity, while brachytherapy provides a direct route for implant-compatible heating and temperature sensing. We systematically mapped the clinical and technical evidence for this combined strategy in pelvic malignancies and reconstructed the selection pathway during major revision. The clinical core comprised 15 reports representing 14 independent studies. Two randomised trials did not demonstrate clinical benefit from the historical regimens as delivered; most of the remaining evidence was non-comparative. Technical feasibility has advanced faster than clinical validation, and limited spatial thermometry and inconsistent thermal dose reporting remain the principal barriers. The most defensible near-term strategy is therefore not immediate routine adoption, but staged development: a minimum reporting dataset, platform qualification, thermally verified workflow studies, and only then disease-specific comparative trials.