Survival Up, Cancer Therapy Usage Down

Cervical cancer brachytherapy usage declining

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) One female cancer has been on the decline in recent years. Cervical cancer cases are being prevented, in part, because of vaccines against the cancer-causing virus called human papillomavirus (HPV). The ways the cancer is being treated are changing too.

New research has demonstrated that a type of internal radiation therapy called brachytherapy helped cervical cancer survivors live longer.

While the therapy is considered part of the standard of care for cervical cancer, brachytherapy use is declining, particularly in certain geographic areas, the study revealed.

"Ask questions about the specifics of your cancer therapy."

Akila Viswanathan, MD, MPH, director of Gynecologic Radiation Oncology at Brigham and Women's Hospital in Boston, MA, and colleagues at Princess Margaret Hospital in Toronto, Canada, conducted this study.

The standard treatment of locally advanced cervical cancer that has spread beyond the cervix includes external beam radiation therapy (EBRT), in which a single or multiple beams of radiation target the tumor.

Chemotherapy is given at the same time as EBRT, followed by brachytherapy, in which radioactive agents are implanted near the tumor.

“Brachytherapy is an essential component of treatment that escalates the dose of radiation to the primary tumor while minimizing the dose to critical organs [bladder and bowel] at risk,” the authors wrote.

To analyze the survival benefits of brachytherapy, along with usage, the researchers used the Surveillance, Epidemiology and End Results (SEER) database to identify 7,359 cervical cancer patients who had received EBRT between 1988 and 2009.

The investigators compared survival rates among women who did and did not receive brachytherapy as part of their cervical cancer treatment.

The four-year cause-specific survival rate of women who received brachytherapy was 64.3 percent, compared to 51.5 percent among women who had EBRT alone. This means that of the women who ended up dying specifically from cervical cancer, more were alive at four years in the group that had brachytherapy.

Four-year overall survival was 58.2 percent for women who had brachytherapy versus 46.2 percent for those who received only EBRT.

Of the entire group, 63 percent received brachytherapy in addition to EBRT, while 37 percent of the cervical cancer patients were treated only with EBRT.

Those who received the internal radiation therapy tended to be younger and married, have earlier stage cancers and live in certain areas of the country.

The researchers discovered that brachytherapy use fell over 30 percent during the study period, from being used in 83 percent of patients in 1988 to 58 percent in 2009.

Geographic areas that saw the biggest drops in use were California, New Jersey, Georgia and Connecticut.

The authors noted that this trend may be the result of the decline in the number of cervical cancer cases and the use of other types of radiation therapy.

“Brachytherapy use was independently associated with significantly higher cause-specific and overall survival rates and should be implemented in all feasible cases,” the authors concluded.

This research was published in the September issue of the International Journal of Radiation Oncology.

The Canadian Association of Radiation Oncology-Elekta fellowship funded this research. No conflicts of interest were reported.

Review Date: 
September 12, 2013
Last Updated:
September 12, 2013