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

Brachytherapy-integrated hyperthermia combines implant-based radiation delivery with localized heating, but the evidence spans heterogeneous diseases, devices, temperature measurements, and study designs. We conducted a systematic search-based evidence map with revision-stage record reconciliation, human adjudication, report-to-study linkage, and design-matched clinical appraisal. Of 8189 unique records screened in the original search, 2178 candidate or uncertain records underwent documented revision-stage human adjudication. During acceptance-stage revision, all 3919 records originally assigned to the machine exclusion stratum also received a primary human title/abstract re-screen decision; 3916 exclusions were confirmed and three boundary records were reclassified. The final unified worklist comprised 285 records. Ninety-two verified/supporting report units were adjudicated (15 direct clinical, 34 technical/platform, 24 supporting, and 19 excluded). The 15 core clinical reports represented 14 independent studies and generated 17 appraisal records using RoB 2, ROBINS-I, and JBI tools. Two randomised phase III trials did not show improved disease control or survival with added hyperthermia; both were judged to raise some concerns for risk of bias, and both had important thermal intervention limitations. One non-randomised cervical comparison was at serious risk of bias from confounding by indication. Uncontrolled prostate, anal, gynaecologic, and mixed pelvic series supported procedural feasibility but not causal efficacy. Two predefined supplemental saturation batches added no new eligible evidence in any family or domain. The evidence supports standardised multipoint thermometry, measurement-anchored spatial reconstruction, coupled planning, platform qualification, and disease-specific trials only after thermal fidelity gates are passed.