A study led by Akila Viswanathan, MD, MPH, director of BWH Gynecologic Radiation Oncology, found a disturbing decline in lifesaving treatment for cervical cancer. Brachytherapy treatment 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 standard treatment of locally advanced cervical cancer is external beam radiation therapy (EBRT) with concurrent chemotherapy, followed by brachytherapy.
The researchers used the Surveillance, Epidemiology, and End Results (SEER) Database to identify 7,359 patients with advanced stage cervical cancer treated with EBRT between 1988 and 2009. Of the 7,359 patients identified, the researchers found that 63 percent of these women received brachytherapy in combination with EBRT, and 37 percent received EBRT 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 percent in 1988 to 58 percent in 2009. There was a sharp decline from 43 percent to 23 percent in 2003. The researchers noted that the decline may be related to the increased adoption of alternative treatment techniques, such as intensity modulated radiation therapy and stereotactic body radiation therapy.
In terms of patient survival, brachytherapy was associated with a higher four-year cause-specific survival (64.3 percent vs. 51.5 percent) and overall survival (58.2 percent vs. 46.2 percent) compared to EBRT alone. Brachytherapy treatment was also independently associated with better cause-specific survival and overall survival.
The study was published in the September 2013 issue of The International Journal of Radiation Oncology.