title: Patterns of radiotherapy practice for patients with cervical cancer in Japan, 2003-2005: changing trends in the pattern of care process.
abstract: OBJECTIVE
  The patterns of care study (PCS) of radiotherapy for cervical cancer in Japan over the last 10 years was reviewed.
  
  
  METHODS
  The Japanese PCS working group analyzed data from 1,200 patients (1995-1997, 591 patients; 1999-2001, 324 patients; 2003-2005, 285 patients) with cervical cancer treated with definitive radiotherapy in Japan.
  
  
  RESULTS
  Patients in the 2001-2003 survey were significantly younger than those in the 1999-2001 study (p < 0.0001). Histology, performance status, and International Federation of Gynecology and Obstetrics stage were not significantly different among the three survey periods. Use of combinations of chemotherapy has increased significantly during those periods (1995-1997, 24%; 1999-2001, 33%; 2003-2005, 54%; p < 0.0001). The ratio of patients receiving concurrent chemotherapy has also dramatically increased (1995-1997, 20%; 1999-2001, 54%; 2003-2005, 83%; p < 0.0001). As for external beam radiotherapy (EBRT), the application rate of four-field portals has greatly increased over the three survey periods (1995-1997, 2%; 1999-2001, 7%; 2003-2005, 21%; p < 0.0001). In addition, the use of an appropriate beam energy for EBRT has shown an increase (1995-1997, 67%; 1999-2001, 74%; 2003-2005, 81%; p = 0.064). As for intracavitary brachytherapy (ICBT), an iridium source has become increasingly popular (1995-1997, 27%; 1999-2001, 42%; 2003-2005, 84%; p < 0.0001). Among the three surveys, the ratio of patients receiving ICBT (1995-1997, 77%; 1999-2001, 82%; 2003-2005, 78%) has not changed. Although follow-up was inadequate in each survey, no significant survival differences were observed (p = 0.36), and rates of late Grade 3 or higher toxicity were significantly different (p = 0.016).
  
  
  CONCLUSIONS
  The Japanese PCS has monitored consistent improvements over the past 10 years in the application of chemotherapy, timing of chemotherapy, and EBRT methods. However, there is still room for improvement, especially in the clinical practice of ICBT.
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan. ntomita@aichi-cc.jp
authors.forename: Natsuo
authors.initials: N
authors.lastname: Tomita
authors.forename: Takafumi
authors.initials: T
authors.lastname: Toita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.forename: Atsunori
authors.initials: A
authors.lastname: Shinoda
authors.forename: Takashi
authors.initials: T
authors.lastname: Uno
authors.forename: Hodaka
authors.initials: H
authors.lastname: Numasaki
authors.forename: Teruki
authors.initials: T
authors.lastname: Teshima
authors.forename: Michihide
authors.initials: M
authors.lastname: Mitsumori
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods / Q000639:trends; D059248:Chemoradiotherapy / Q000706:statistics & numerical data / Q000639:trends; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D011832:Radiation Injuries / Q000453:epidemiology / Q000473:pathology; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods / Q000639:trends; D011879:Radiotherapy Dosage; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D007496:Iridium Radioisotopes