Abstract
PURPOSE
To examine trends, characteristics, and outcomes related to addition of vaginal brachytherapy
(VBT) to external beam radiotherapy (EBRT) for adjuvant radiotherapy in high-risk
early-stage cervical cancer.
METHODS AND MATERIALS
This comparative study is a retrospective observational analysis of the National Cancer
Institutes’ Surveillance, Epidemiology, and End Results Program. Surgically treated
women with stage T1-2 cervical cancer who had high-risk factors (nodal metastasis
and/or parametrial invasion) and received adjuvant radiotherapy from 2000 to 2018
were examined. Propensity score inverse probability of treatment weighting was used
to assess the survival estimates for addition of VBT use.
RESULTS
Among 2470 women with high-risk factors receiving EBRT, 760 (30.8%) had additional
VBT. During the study period, there was an increasing trend of VBT use from 27.4%
to 36.1% (p< 0.001). In a multivariable analysis, year of diagnosis and high-risk tumor factors:
parametrial involvement, large tumor size, and use of chemotherapy remained independent
characteristics associated with VBT use (all, p< 0.05). In propensity score-weighted models, VBT use with EBRT and EBRT alone had
comparable overall survival (5-year rates 73.8% vs. 77.4%, hazard ratio [HR] 1.07,
95% confidence interval [CI] 0.92–1.25). Nonsignificant association was also observed
in squamous or nonsquamous tumors, young or old age, low or high nodal ratio, chemotherapy
use, and simple or radical hysterectomy (all, p> 0.05). Lastly, the addition of VBT was not associated with cervical cancer-specific
survival (subdistribution-HR 1.15, 95% CI 0.94–1.41).
CONCLUSIONS
Utilization of VBT with EBRT for adjuvant radiotherapy in high-risk early-stage cervical
cancer is increasing in the United States. Addition of VBT was associated with neither
overall survival nor cancer-specific survival.
Keywords
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Article info
Publication history
Published online: October 28, 2021
Accepted:
September 18,
2021
Received in revised form:
September 11,
2021
Received:
August 19,
2021
Footnotes
Disclosures: Consultant, Quantgene (LDR); honorarium, Chugai, textbook editorial expense, Springer, investigator meeting attendance expense, VBL Therapeutics (KM) (all, outside this work). This work was supported by Ensign Endowment for Gynecologic Cancer Research (KM). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Abstract presentation: 103rd Annual Meeting of American Radium Society, Maui, HI, September 29–October 3, 2021.
Identification
Copyright
© 2021 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
