Trends in the utilization of brachytherapy in cervical cancer in the United States

Kathy Han, Michael Milosevic, Anthony Fyles, Melania Pintilie, Akila Viswanathan

Research output: Contribution to journalArticle

Abstract

Purpose: To determine the trends in brachytherapy use in cervical cancer in the United States and to identify factors and survival benefits associated with brachytherapy treatment. Methods and Materials Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 7359 patients with stages IB2-IVA cervical cancer treated with external beam radiation therapy (EBRT) between 1988 and 2009. Propensity score matching was used to adjust for differences between patients who received brachytherapy and those who did not from 2000 onward (after the National Cancer Institute alert recommending concurrent chemotherapy). Results Sixty-three percent of the 7359 women received brachytherapy in combination with EBRT, and 37% received EBRT alone. The brachytherapy utilization rate has decreased from 83% in 1988 to 58% in 2009 (P<.001), with a sharp decline of 23% in 2003 to 43%. Factors associated with higher odds of brachytherapy use include younger age, married (vs single) patients, earlier years of diagnosis, earlier stage and certain SEER regions. In the propensity score-matched cohort, brachytherapy treatment was associated with higher 4-year cause-specific survival (CSS; 64.3% vs 51.5%, P<.001) and overall survival (OS; 58.2% vs 46.2%, P<.001). Brachytherapy treatment was independently associated with better CSS (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.57-0.71), and OS (HR 0.66; 95% CI, 0.60 to 0.74). Conclusions This population-based analysis reveals a concerning decline in brachytherapy utilization and significant geographic disparities in the delivery of brachytherapy in the United States. Brachytherapy use is independently associated with significantly higher CSS and OS and should be implemented in all feasible cases.

Original languageEnglish (US)
Pages (from-to)111-119
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume87
Issue number1
DOIs
StatePublished - Sep 1 2013
Externally publishedYes

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Brachytherapy
Uterine Cervical Neoplasms
epidemiology
radiation therapy
cancer
surveillance
trends
hazards
confidence
intervals
chemotherapy
delivery
Propensity Score
Radiotherapy
causes
Survival
Epidemiology
Confidence Intervals
National Cancer Institute (U.S.)
Early Diagnosis

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Trends in the utilization of brachytherapy in cervical cancer in the United States. / Han, Kathy; Milosevic, Michael; Fyles, Anthony; Pintilie, Melania; Viswanathan, Akila.

In: International Journal of Radiation Oncology Biology Physics, Vol. 87, No. 1, 01.09.2013, p. 111-119.

Research output: Contribution to journalArticle

Han, Kathy ; Milosevic, Michael ; Fyles, Anthony ; Pintilie, Melania ; Viswanathan, Akila. / Trends in the utilization of brachytherapy in cervical cancer in the United States. In: International Journal of Radiation Oncology Biology Physics. 2013 ; Vol. 87, No. 1. pp. 111-119.
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abstract = "Purpose: To determine the trends in brachytherapy use in cervical cancer in the United States and to identify factors and survival benefits associated with brachytherapy treatment. Methods and Materials Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 7359 patients with stages IB2-IVA cervical cancer treated with external beam radiation therapy (EBRT) between 1988 and 2009. Propensity score matching was used to adjust for differences between patients who received brachytherapy and those who did not from 2000 onward (after the National Cancer Institute alert recommending concurrent chemotherapy). Results Sixty-three percent of the 7359 women received brachytherapy in combination with EBRT, and 37{\%} received EBRT alone. The brachytherapy utilization rate has decreased from 83{\%} in 1988 to 58{\%} in 2009 (P<.001), with a sharp decline of 23{\%} in 2003 to 43{\%}. Factors associated with higher odds of brachytherapy use include younger age, married (vs single) patients, earlier years of diagnosis, earlier stage and certain SEER regions. In the propensity score-matched cohort, brachytherapy treatment was associated with higher 4-year cause-specific survival (CSS; 64.3{\%} vs 51.5{\%}, P<.001) and overall survival (OS; 58.2{\%} vs 46.2{\%}, P<.001). Brachytherapy treatment was independently associated with better CSS (hazard ratio [HR], 0.64; 95{\%} confidence interval [CI], 0.57-0.71), and OS (HR 0.66; 95{\%} CI, 0.60 to 0.74). Conclusions This population-based analysis reveals a concerning decline in brachytherapy utilization and significant geographic disparities in the delivery of brachytherapy in the United States. Brachytherapy use is independently associated with significantly higher CSS and OS and should be implemented in all feasible cases.",
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AB - Purpose: To determine the trends in brachytherapy use in cervical cancer in the United States and to identify factors and survival benefits associated with brachytherapy treatment. Methods and Materials Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 7359 patients with stages IB2-IVA cervical cancer treated with external beam radiation therapy (EBRT) between 1988 and 2009. Propensity score matching was used to adjust for differences between patients who received brachytherapy and those who did not from 2000 onward (after the National Cancer Institute alert recommending concurrent chemotherapy). Results Sixty-three percent of the 7359 women received brachytherapy in combination with EBRT, and 37% received EBRT alone. The brachytherapy utilization rate has decreased from 83% in 1988 to 58% in 2009 (P<.001), with a sharp decline of 23% in 2003 to 43%. Factors associated with higher odds of brachytherapy use include younger age, married (vs single) patients, earlier years of diagnosis, earlier stage and certain SEER regions. In the propensity score-matched cohort, brachytherapy treatment was associated with higher 4-year cause-specific survival (CSS; 64.3% vs 51.5%, P<.001) and overall survival (OS; 58.2% vs 46.2%, P<.001). Brachytherapy treatment was independently associated with better CSS (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.57-0.71), and OS (HR 0.66; 95% CI, 0.60 to 0.74). Conclusions This population-based analysis reveals a concerning decline in brachytherapy utilization and significant geographic disparities in the delivery of brachytherapy in the United States. Brachytherapy use is independently associated with significantly higher CSS and OS and should be implemented in all feasible cases.

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