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In This Issue:
Akila Viswanathan
Brachytherapy-a procedure that involves escalating the dose of radiation to the primary tumor while minimizing the dose to critical surrounding organs-is part of standard treatment for advanced cervical cancer.
A recent study by Akila Viswanathan, MD, MPH, director of BWH Gynecologic Radiation Oncology, found that brachytherapy treatment was associated with better overall survival in women with cervical cancer. However, the study also revealed a decline in brachytherapy treatment in the U.S.
So why the decline in a treatment associated with better overall survival?
Researchers identified more than 7,000 patients with advanced stage cervical cancer treated with external beam radiation therapy between 1988 and 2009. External beam radiation is a type of cancer treatment that uses a large machine to aim high doses of radiation to the body to destroy cancer cells.
Researchers found that 63 percent of these women received brachytherapy in combination with external beam radiation therapy, and 37 percent received external beam radiation therapy alone.
Factors associated with higher odds of brachytherapy use included younger age, being married, earlier year and/or stage of diagnosis and certain geographic regions.
Moreover, brachytherapy usage rate decreased from 83 percent in 1988 to 58 percent in 2009, with a sharp decline from 43 percent to 23 percent in 2003. Researchers noted that the decline may be related to an increased adoption of alternative radiation treatment techniques, among other reasons.
In terms of patient survival, brachytherapy was associated with a higher four-year cause-specific survival-the likelihood of not having cancer four years after diagnosis-(64.3 percent vs. 51.5 percent), as well as overall survival (58.2 percent vs. 46.2 percent) compared to external beam radiation therapy alone. Brachytherapy treatment was also independently associated with better cause-specific survival and overall survival.
"The shift away from brachytherapy is concerning and has directly lowered the survival rates of cervical cancer patients," said Viswanathan. "High-quality brachytherapy must continue to be used, ideally with image-guidance, to maximize survival and minimize toxicity."