ABSTRACT
Brachytherapy is a critical component of the definitive management of cervical cancer
and allows for the safe delivery of about half of the total effective radiation dose
needed for optimal outcomes. Moreover, the dose distribution of brachytherapy is highly
conformal, allowing for a therapeutic index currently unmatched by alternative techniques.
However, a modern brachytherapy program requires special equipment, infrastructure,
and procedural expertise. Unfortunately, multiple lines of evidence suggest that brachytherapy
is currently underutilized in the United States. In this review, we examine the importance
of brachytherapy, contemporary recommendations, and avenues for growth.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to BrachytherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics.CA Cancer J Clin. 2022; 72 (2022): 7-33https://doi.org/10.3322/caac.21708
- HPV vaccination and the risk of invasive cervical cancer.N Engl J Med. 2020; 383: 1340-1348https://doi.org/10.1056/NEJMoa1917338
- Human papillomavirus vaccination and trends in cervical cancer incidence and mortality in the US.JAMA Pediatrics. 2022; 176: 313-316https://doi.org/10.1001/jamapediatrics.2021.4807
- Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature.Hum Vaccin Immunother. 2019; 15: 146-155https://doi.org/10.1080/21645515.2018.1512453
- Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis.Lancet North Am Ed. 2001; 358: 781-786https://doi.org/10.1016/S0140-6736(01)05965-7
- Tumor and treatment factors improving outcome in stage III-B cervix cancer.Int J Radiat Oncol*Biol*Phys. 1991; 20: 95-100https://doi.org/10.1016/0360-3016(91)90143-R
- Brachytherapy in gynecologic cancers: why is it underused?.Curr Oncol Rep. 2016; 18: 26https://doi.org/10.1007/s11912-016-0508-y
- Disparities in standard of care treatment and associated survival decrement in patients with locally advanced cervical cancer.Gynecol Oncol. 2016; 143: 319-325https://doi.org/10.1016/j.ygyno.2016.09.009
- MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study.Lancet Oncol. 2021; 22: 538-547https://doi.org/10.1016/S1470-2045(20)30753-1
- Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: Results of the French STIC prospective study.Radiother Oncol. 2012; 103: 305-313https://doi.org/10.1016/j.radonc.2012.04.007
- The cost-effectiveness and value proposition of brachytherapy.Semin Radiat Oncol. 2020; 30: 87-93https://doi.org/10.1016/j.semradonc.2019.08.007
- Cost-effectiveness analysis of 3D image-guided brachytherapy compared with 2D brachytherapy in the treatment of locally advanced cervical cancer.Brachytherapy. 2015; 14: 29-36https://doi.org/10.1016/j.brachy.2014.09.002
- Trends in the utilization of brachytherapy in cervical cancer in the United States.Int J Radiat Oncol*Biol*Phys. 2013; 87: 111-119https://doi.org/10.1016/j.ijrobp.2013.05.033
- National cancer data base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements.Int J Radiat Oncol*Biol*Phys. 2014; 90: 1083-1090https://doi.org/10.1016/j.ijrobp.2014.07.017
- A phase II trial of stereotactic ablative radiation therapy as a boost for locally advanced cervical cancer.Int J Radiat Oncol*Biol*Phys. 2020; 106: 464-471https://doi.org/10.1016/j.ijrobp.2019.10.042
NCCN Clinical Practice Guidelines in Oncology. Cervical Cancer, Version 1.2022. https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf
- American brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part I: General principles.Brachytherapy. 2012; 11: 33-46https://doi.org/10.1016/j.brachy.2011.07.003
- American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part II: High-dose-rate brachytherapy.Brachytherapy. 2012; 11: 47-52https://doi.org/10.1016/j.brachy.2011.07.002
- Brachytherapy: a critical component of primary radiation therapy for cervical cancer: From the Society of Gynecologic Oncology (SGO) and the American Brachytherapy Society (ABS).Brachytherapy. 2019; 18: 123-132https://doi.org/10.1016/j.brachy.2018.11.009
- Patterns of care with brachytherapy for cervical cancer.Int J Gynecol Cancer. 2014; 24https://doi.org/10.1097/IGC.0000000000000276
- Socioeconomic and racial determinants of brachytherapy utilization for cervical cancer: concerns for widening disparities.JCO Oncol Pract. 2021; 17: e1958-e1967https://doi.org/10.1200/OP.21.00291
- Patterns of radiation therapy practice for patients treated for intact cervical cancer in 2005 to 2007: a quality research in radiation oncology study.Int J Radiat Oncol*Biol*Phys. 2014; 89: 249-256https://doi.org/10.1016/j.ijrobp.2013.11.228
- Patterns of radiotherapy practice for patients with squamous carcinoma of the uterine cervix: patterns of care study.Int J Radiat Oncol Biol Phys. 1999; 43: 351-358https://doi.org/10.1016/S0360-3016(98)00401-5
- Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California.Gynecol Oncol. 2018; 150: 73-78https://doi.org/10.1016/j.ygyno.2018.04.563
- Declining brachytherapy utilization for cervical cancer patients - Have we reversed the trend?.Gynecol Oncol. 2020; 156: 583-590https://doi.org/10.1016/j.ygyno.2019.12.032
- Bias Reduction through Analysis of Competing Events (BRACE) correction to address cancer treatment selection bias in observational data.Clin Cancer Res. 2022; 28: 1832-1840https://doi.org/10.1158/1078-0432.CCR-21-2468
- Brachytherapy utilization for cervical cancer in Western United States border counties: seeking to understand referral patterns for outcome improvement.J Contemp Brachyther. 2021; 13: 620-626https://doi.org/10.5114/jcb.2021.112112
- Understanding the underutilization of cervical brachytherapy for locally advanced cervical cancer.Brachytherapy. 2019; 18: 361-369https://doi.org/10.1016/j.brachy.2018.12.002
- Geographic access to brachytherapy services in the United States.Brachytherapy. 2022; 21: 29-32https://doi.org/10.1016/j.brachy.2021.05.004
- Brachytherapy training survey of radiation oncology residents.Int J Radiat Oncol Biol Phys. 2019; 103: 557-560https://doi.org/10.1016/j.ijrobp.2018.10.023
- How might financial pressures have impacted brachytherapy? A proposed narrative to explain the declines in cervical and prostate brachytherapy utilization.Brachytherapy. 2019; 18: 780-786https://doi.org/10.1016/j.brachy.2019.07.001
- Evaluation of delivery costs for external beam radiation therapy and brachytherapy for locally advanced cervical cancer using time-driven activity-based costing.Int J Radiat Oncol Biol Phys. 2018; 100: 88-94https://doi.org/10.1016/j.ijrobp.2017.09.004
- Stereotactic Body Radiation Therapy (SBRT) can be dosimetrically equivalent to high-dose brachytherapy as a boost for locally advanced cervical cancer— a new clinical trial concept.Int J Radiat Oncol Biol Phys. 2012; 84: S428https://doi.org/10.1016/j.ijrobp.2012.07.1134
- #ThisIsBrachytherapy: increasing awareness of brachytherapy.Brachytherapy. 2021; 20: 232-236https://doi.org/10.1016/j.brachy.2020.07.003
- Proficiency-based cervical cancer brachytherapy training.Brachytherapy. 2018; 17: 653-659https://doi.org/10.1016/j.brachy.2018.03.001
- Treatment of cervical cancer: overcoming challenges in access to brachytherapy.Expert Rev Anticancer Ther. 2022; 22: 353-359https://doi.org/10.1080/14737140.2022.2047936
- Increasing global access to brachytherapy: The ABS 300 in 10 initiative and ongoing international efforts.Brachytherapy. 2022; 21: 1-3https://doi.org/10.1016/j.brachy.2021.09.003
- Increasing brachytherapy mentorship and representation through #NextGenBrachy.Int J Radiat Oncol Biol Phys. 2021; 111: e15https://doi.org/10.1016/j.ijrobp.2021.05.163
- Compendium of fractionation choices for gynecologic HDR brachytherapy-An American brachytherapy society task group report.Brachytherapy. 2019; 18: 429-436https://doi.org/10.1016/j.brachy.2019.02.008
- Workflow and efficiency in MRI-based high-dose-rate brachytherapy for cervical cancer in a high-volume brachytherapy center.Brachytherapy. 2018; 17: 753-760https://doi.org/10.1016/j.brachy.2018.05.001
Article info
Publication history
Published online: December 08, 2022
Accepted:
October 12,
2022
Received:
September 9,
2022
Footnotes
Disclosures: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
The authors reports no conflict of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of American Brachytherapy Society.
