title: Postoperative radiotherapy use and patterns of care analysis for node positive or parametria positive cervical cancer.
abstract: OBJECTIVE
  The objective of this study is to perform a patterns of care analysis for post-hysterectomy patients with node positive (LN+) or parametria positive cervical cancer.
  
  
  METHODS
  A retrospective analysis was conducted utilizing the Surveillance, Epidemiology and End Results (SEER) Program from 1973 to 2006. We identified 2247 women with cervical carcinoma who had undergone hysterectomy and were found to have LN+ and/or positive parametria.
  
  
  RESULTS
  Of the 2247 identified, 80.1% (1800) received postoperative radiotherapy (RT) while 19.9% (447) did not. Of those receiving RT, a significantly greater proportion had worse risk factors including higher clinical stage, and nodal bulk yet cause-specific survival (CSS) was equivalent between the two groups. RT utilization has increased over time from 67.2% in the cohort analyzed from 1973 to 1982 to 81.8% in the cohort analyzed from 2004 to 2006 (p = 0.0003). Blacks had worse CSS than whites (HR 1.35, 95% CI [1.05, 1.75]; p = 0.02). The proportion of those receiving RT was lower in blacks than whites (74.7% vs. 80.5%; p = 0.0358). From 1973 to 1982, 87.5% of blacks received RT while 62% of whites received RT (p = 0.0463). From 2004 to 2006, 64.4% of blacks received RT while 83.0% of whites received RT (p = 0.0024).
  
  
  CONCLUSIONS
  Despite randomized data supporting the use of postoperative concurrent chemoradiotherapy for LN+ or parametria positive cervical cancer, the proportion of blacks not receiving RT is increasing over time. This is the largest patterns of care analysis to date of RT in patients with LN+ and/or parametria positive cervical cancer.
authors.affiliation: Huntsman Cancer Institute, University of Utah, USA. amol.ghia@hci.utah.edu
authors.forename: Amol J
authors.initials: AJ
authors.lastname: Ghia
authors.forename: E Shannon
authors.initials: ES
authors.lastname: Neeley
authors.forename: David K
authors.initials: DK
authors.lastname: Gaffney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006176:Gynecology / Q000379:methods; D006801:Humans; D008207:Lymphatic Metastasis; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011182:Postoperative Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D055815:Young Adult