Survival higher with brachytherapy for cervical cancer but use declines in US

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Brachytherapy treatment was found to be associated with better cause-specific survival and overall survival in women with cervical cancer in a new study. The population-based analysis also revealed geographic disparities and a decline in brachytherapy treatment in the United States.

Brachytherapy is a type of cancer treatment in which radioactive implants are inserted directly into the tissue near the tumor site. The research team, from Brigham and Women's Hospital in Boston, Massachusetts, used the Surveillance, Epidemiology, and End Results (SEER) database to identify 7,359 patients with advanced stage cervical cancer who were treated with external beam radiation therapy (EBRT) between 1988 and 2009. The SEER population-based registries cover about 28% of the US population.

Of the 7,359 patients identified, 63% were found to have received brachytherapy in combination with EBRT, and 37% received EBRT alone. Odds were higher for having received brachytherapy if patients were younger, married, in earlier years of diagnosis, in earlier stages, or lived in certain SEER regions. The study was published in The International Journal of Radiation Oncology (2013; 87(1):111-119).

The rate of brachytherapy usage decreased from 83% in 1988 to 58% in 2009, with a sharp decline from 43% to 23% occurring in 2003. The research team 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.

Patient survival was higher with brachytherapy. Compared with EBRT alone, both 4-year cause-specific survival (64.3% vs 51.5%) and overall survival (58.2% vs 46.2%) were higher with brachytherapy. Also, brachytherapy was 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 Brigham and Women's Hospital Gynecologic Radiation Oncology. "High-quality brachytherapy must continue to be used, ideally with image guidance, to maximize survival and minimize toxicity."

Brachytherapy is an important component of treatment that escalates the dose of radiation to the primary tumor while minimizing the dose to critical organs at risk. The standard treatment of locally advanced cervical cancer is EBRT with concurrent chemotherapy, followed by brachytherapy.

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