The Role of Brachytherapy in the Management of Oral Squamous Cell Carcinoma: A Systematic Review

Background: This systematic review evaluates the effectiveness and safety of brachytherapy (BT), including low-dose-rate (LDR) and high-dose-rate (HDR) techniques, in the treatment of oral squamous cell carcinoma (OSCC). Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science up to April 2025, according to PRISMA guidelines. The review was registered in PROSPERO (CRD42024581512). Eligible studies included cohort, case-control, and longitudinal studies in English investigating BT in OSCC patients. Risk of bias was assessed using ROBINS-I. Results: A total of 26 studies with 2286 patients were included where BT was employed as primary or adjuvant therapy, primarily for tumors of the tongue and floor of the mouth. Local control rates ranged from 72% to 95% for both LDR and HDR. HDR BT showed similar efficacy to LDR and offered logistical advantages. Acute and late toxicities included mucositis, soft tissue necrosis, and osteoradionecrosis, particularly with higher doses and large volumes. Combined BT and external beam radiotherapy (EBRT) improved outcomes in selected patients. Conclusions: BT remains an effective, organ-preserving option for early-stage OSCC. HDR BT is increasingly adopted due to its comparable efficacy and improved practicality. Optimal patient selection and precise dosimetric planning are crucial to minimize complications. Further prospective studies are warranted to define its role in modern multimodal treatment strategies.