Journal article
National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements
International journal of radiation oncology, biology, physics, v 90(5), pp 1083-1090
01 Dec 2014
PMID: 25216857
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
To utilize the National Cancer Data Base to evaluate trends in brachytherapy and alternative radiation therapy utilization in the treatment of cervical cancer, to identify associations with outcomes between the various radiation therapy modalities.
Patients with International Federation of Gynecology and Obstetrics stage IIB-IVA cervical cancer in the National Cancer Data Base who received treatment from January 2004 to December 2011 were analyzed. Overall survival was estimated by the Kaplan-Meier method. Univariate and multivariable analyses were performed to identify factors associated with type of boost radiation modality used and its impact on survival.
A total of 7654 patients had information regarding boost modality. A predominant proportion of patients were Caucasian (76.2%), had stage IIIB (48.9%) disease with squamous (82.0%) histology, were treated at academic/research centers (47.7%) in the South (34.8%), and lived 0 to 5 miles (27.9%) from the treating facility. A majority received brachytherapy (90.3%). From 2004 to 2011, brachytherapy use decreased from 96.7% to 86.1%, whereas intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) use increased from 3.3% to 13.9% in the same period (P<.01). Factors associated with decreased brachytherapy utilization included older age, stage IVA disease, smaller tumor size, later year of diagnosis, lower-volume treatment centers, and facility type. After controlling for significant factors from survival analyses, IMRT or SBRT boost resulted in inferior overall survival (hazard ratio, 1.86; 95% confidence interval, 1.35-2.55; P<.01) as compared with brachytherapy. In fact, the survival detriment associated with IMRT or SBRT boost was stronger than that associated with excluding chemotherapy (hazard ratio, 1.61' 95% confidence interval, 1.27-2.04' P<.01).
Consolidation brachytherapy is a critical treatment component for locally advanced cervical cancer; however, there has been declining utilization of brachytherapy. Increased use of IMRT and SBRT boost coupled with increased mortality risk should raise concerns about utilizing these approaches over brachytherapy.
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Details
- Title
- National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements
- Creators
- Beant S Gill - University of PittsburghJeff F Lin - University of PittsburghThomas C Krivak - Western Pennsylvania HospitalPaniti Sukumvanich - University of PittsburghRobin A Laskey - University of PittsburghMalcolm S Ross - University of PittsburghJamie L Lesnock - University of PittsburghSushil Beriwal - University of Pittsburgh
- Publication Details
- International journal of radiation oncology, biology, physics, v 90(5), pp 1083-1090
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000346414500019
- Scopus ID
- 2-s2.0-84920177839
- Other Identifier
- 991021897369504721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Oncology
- Radiology, Nuclear Medicine & Medical Imaging