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Brachytherapy to Treat Cervical Cancer on the Decline in the United States

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Key Points

  • Brachytherapy usage has decreased from 83% in 1988 to 58% in 2009, with a sharp decline of 23% in 2003 to 43%.
  • Brachytherapy was associated with a higher 4-year cause-specific survival and overall survival compared to external-beam radiation therapy alone.
  • The decline may be related to the decreasing incidence of cervical cancer and increased adoption of alternative treatment techniques such as intensity-modulated radiation therapy and stereotactic body radiation therapy.

A study by researchers at Brigham and Women's Hospital found that brachytherapy was associated with better cause-specific survival and overall survival in women with cervical cancer. The population-based analysis also revealed geographic disparities and decline in brachytherapy treatment in the United States. The study was published in the September 2013 issue of The International Journal of Radiation Oncology.

Study Details

The researchers used the Surveillance, Epidemiology, and End Results (SEER) Database to identify 7,359 patients with advanced-stage cervical cancer treated with external-beam radiation therapy between 1988 and 2009.

Of the 7,359 patients identified, the researchers found that 63% of these women received brachytherapy in combination with external-beam radiotherapy, and 37% received external-beam radiotherapy alone. Factors associated with higher odds of brachytherapy use included younger age, being married, earlier years of diagnosis, earlier stage, and certain SEER regions.

Moreover, brachytherapy usage rate decreased from 83% in 1988 to 58% in 2009. There was a sharp decline of 23% in 2003 to 43%. The researchers noted that the decline may be related to the decreasing incidence of cervical cancer and increased adoption of alternative treatment techniques, such as intensity-modulated radiation therapy and stereotactic body radiation therapy.

Brachytherapy Associated With Higher Survival Rates

In terms of patient survival, brachytherapy was associated with a higher 4-year cause-specific survival (64.3% vs 51.5%) and overall survival (58.2% vs 46.2%) compared to external-beam radiation therapy alone. Brachytherapy treatment was also independently associated with better cause-specific survival and overall survival.

"The shift away from brachytherapy is concerning, and has directly lowered the survival rates of cervical cancer patients," said senior study author Akila Viswanathan, MD, MPH, Director of Gynecologic Radiation Oncology at Brigham and Women's Hospital. "High-quality brachytherapy must continue to be used, ideally with image-guidance, to maximize survival and minimize toxicity."

This research was supported by the Canadian Association of Radiation Oncology-Elekta fellowship.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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