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Underutilization of brachytherapy for cervical cancer in the United States

  • Casey W. Williamson
    Affiliations
    Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
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  • Jyoti Mayadev
    Correspondence
    Corresponding author. Gynecologic Oncology Radiation Services, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, Tel.: 85-88-224364, Fax: 85-82-461505.
    Affiliations
    Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
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Published:December 08, 2022DOI:https://doi.org/10.1016/j.brachy.2022.10.004

      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

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      References

        • Siegel RL
        • Miller KD
        • Fuchs HE
        • Jemal A.
        Cancer statistics.
        CA Cancer J Clin. 2022; 72 (2022): 7-33https://doi.org/10.3322/caac.21708
        • Lei J
        • Ploner A
        • Elfström KM
        • et al.
        HPV vaccination and the risk of invasive cervical cancer.
        N Engl J Med. 2020; 383: 1340-1348https://doi.org/10.1056/NEJMoa1917338
        • Tabibi T
        • Barnes JM
        • Shah A
        • et al.
        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
        • Hirth J.
        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
        • Green JA
        • Kirwan JM
        • Tierney JF
        • et al.
        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
        • Lanciano RM
        • Martz K
        • Coia LR
        • Hanks GE.
        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
        • Han K
        • Viswanathan AN.
        Brachytherapy in gynecologic cancers: why is it underused?.
        Curr Oncol Rep. 2016; 18: 26https://doi.org/10.1007/s11912-016-0508-y
        • Robin TP
        • Amini A
        • Schefter TE
        • et al.
        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
        • Pötter R
        • Tanderup K
        • Schmid MP
        • et al.
        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
        • Charra-Brunaud C
        • Harter V
        • Delannes M
        • et al.
        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
        • Vu CC
        • Jawad MS
        • Krauss DJ.
        The cost-effectiveness and value proposition of brachytherapy.
        Semin Radiat Oncol. 2020; 30: 87-93https://doi.org/10.1016/j.semradonc.2019.08.007
        • Kim H
        • Rajagopalan MS
        • Beriwal S
        • et al.
        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
        • Han K
        • Milosevic M
        • Fyles A
        • et al.
        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
        • Gill BS
        • Lin JF
        • Krivak TC
        • et al.
        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
        • Albuquerque K
        • Tumati V
        • Lea J
        • et al.
        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
      1. NCCN Clinical Practice Guidelines in Oncology. Cervical Cancer, Version 1.2022. https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf

        • Viswanathan AN
        • Thomadsen B.
        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
        • Viswanathan AN
        • Beriwal S
        • Santos JFDL
        • et al.
        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
        • Holschneider CH
        • Petereit DG
        • Chu C
        • et al.
        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
        • Bagshaw HP
        • Pappas LM
        • Kepka DL
        • et al.
        Patterns of care with brachytherapy for cervical cancer.
        Int J Gynecol Cancer. 2014; 24https://doi.org/10.1097/IGC.0000000000000276
        • Boyce-Fappiano D
        • Nguyen KA
        • Gjyshi O
        • et al.
        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
        • Eifel PJ
        • Ho A
        • Khalid N
        • et al.
        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
        • Eifel PJ
        • Moughan J
        • Owen J
        • et al.
        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
        • Mayadev J
        • Klapheke A
        • Yashar C
        • et al.
        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
        • Schad MD
        • Patel AK
        • Glaser SM
        • et al.
        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
        • Williamson CW
        • Nelson TJ
        • Thompson CA
        • et al.
        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
        • Feng CH
        • McDaniels-Davidson C
        • Martinez ME
        • et al.
        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
        • Ma TM
        • Harkenrider MM
        • Yashar CM
        • et al.
        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
        • Bates JE
        • Thaker NG
        • Parekh A
        • et al.
        Geographic access to brachytherapy services in the United States.
        Brachytherapy. 2022; 21: 29-32https://doi.org/10.1016/j.brachy.2021.05.004
        • Marcrom SR
        • Kahn JM
        • Colbert LE
        • et al.
        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
        • Schad M
        • Kowalchuk R
        • Beriwal S
        • Showalter TN.
        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
        • Bauer-Nilsen K
        • Hill C
        • Trifiletti DM
        • et al.
        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
        • Tumati V
        • Dubas J
        • Pompos A
        • et al.
        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
        • Kahn JM
        • Campbell SR
        • Albert AA
        • et al.
        #ThisIsBrachytherapy: increasing awareness of brachytherapy.
        Brachytherapy. 2021; 20: 232-236https://doi.org/10.1016/j.brachy.2020.07.003
        • Zhao S
        • Francis L
        • Todor D
        • et al.
        Proficiency-based cervical cancer brachytherapy training.
        Brachytherapy. 2018; 17: 653-659https://doi.org/10.1016/j.brachy.2018.03.001
        • Lichter K
        • Anakwenze Akinfenwa C
        • MacDuffie E
        • et al.
        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
        • Petereit DG.
        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
        • Franco I
        • Petereit DG
        • Mourtada F
        • Singer L.
        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
        • Albuquerque K
        • Hrycushko BA
        • Harkenrider MM
        • et al.
        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
        • Kim H
        • Houser CJ
        • Kalash R
        • et al.
        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