title: Estimation of the optimal brachytherapy utilization rate in the treatment of carcinoma of the uterine cervix: review of clinical practice guidelines and primary evidence.
abstract: BACKGROUND
  Brachytherapy (BT) is an integral part of cervical carcinoma treatment. There have been no attempts to estimate the optimal proportion of new cervical carcinoma cases that should be treated with BT, that is, the optimal rate of brachytherapy utilization (BTU).
  
  
  METHODS
  Evidence-based guidelines and primary evidence were used to construct a BTU tree for carcinoma of the uterine cervix. Searches were performed of the epidemiological literature to ascertain the proportion of patients who fulfilled criteria for BT. The robustness of the model was tested by sensitivity analyses and by peer review. A patterns of care study of BT in New South Wales for 2003 was conducted, and actual BTU for cervical carcinoma determined. The differences between optimal and actual rates of BTU were assessed.
  
  
  RESULTS
  The optimal cervical carcinoma BTU was 49% (range, 42% to 50%). In New South Wales in 2003, actual BTU was only 30% of 256 cervical carcinoma patients. The major discrepancy was for FIGO stage IB-IIA disease, where there was an underutilization of BT, estimated to be 15% actual use compared with 47% optimal use. In Surveillance, Epidemiology, and End Results (SEER) areas, there was underutilization for stage IB-IIA (22% actual BTU versus 47% optimal BTU) and for stage IIB-IVA (54% actual BTU versus 100% optimal BTU).
  
  
  CONCLUSIONS
  BT for cervical carcinoma is underutilized in New South Wales and in SEER areas. The authors' model of optimal BTU can be used as a quality assurance tool to provide an evidence-based benchmark against which actual patterns of practice can be measured. The model can also be used to help determine adequacy of BT resource allocation.
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney, Australia. stephen.thompson@sesiahs.health.nsw.gov.au
authors.forename: Stephen
authors.initials: S
authors.lastname: Thompson
authors.forename: Geoff
authors.initials: G
authors.lastname: Delaney
authors.forename: Gabriel Sam
authors.initials: GS
authors.lastname: Gabriel
authors.forename: Susannah
authors.initials: S
authors.lastname: Jacob
authors.forename: Prabir
authors.initials: P
authors.lastname: Das
authors.forename: Michael
authors.initials: M
authors.lastname: Barton
mesh_terms: D019985:Benchmarking; D001918:Brachytherapy / Q000706:statistics & numerical data*; D002277:Carcinoma / Q000628:therapy*; D002584:Cervix Uteri; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000628:therapy*