title: Trends in the utilization of brachytherapy in cervical cancer in the United States.
abstract: OBJECTIVE
  To determine the trends in brachytherapy use in cervical cancer in the United States and to identify factors and survival benefits associated with brachytherapy treatment.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 7359 patients with stages IB2-IVA cervical cancer treated with external beam radiation therapy (EBRT) between 1988 and 2009. Propensity score matching was used to adjust for differences between patients who received brachytherapy and those who did not from 2000 onward (after the National Cancer Institute alert recommending concurrent chemotherapy).
  
  
  RESULTS
  Sixty-three percent of the 7359 women received brachytherapy in combination with EBRT, and 37% received EBRT alone. The brachytherapy utilization rate has decreased from 83% in 1988 to 58% in 2009 (P<.001), with a sharp decline of 23% in 2003 to 43%. Factors associated with higher odds of brachytherapy use include younger age, married (vs single) patients, earlier years of diagnosis, earlier stage and certain SEER regions. In the propensity score-matched cohort, brachytherapy treatment was associated with higher 4-year cause-specific survival (CSS; 64.3% vs 51.5%, P<.001) and overall survival (OS; 58.2% vs 46.2%, P<.001). Brachytherapy treatment was independently associated with better CSS (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.57-0.71), and OS (HR 0.66; 95% CI, 0.60 to 0.74).
  
  
  CONCLUSIONS
  This population-based analysis reveals a concerning decline in brachytherapy utilization and significant geographic disparities in the delivery of brachytherapy in the United States. Brachytherapy use is independently associated with significantly higher CSS and OS and should be implemented in all feasible cases.
authors.affiliation: Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada. Kathy.Han@rmp.uhn.on.ca
authors.forename: Kathy
authors.initials: K
authors.lastname: Han
authors.forename: Michael
authors.initials: M
authors.lastname: Milosevic
authors.forename: Anthony
authors.initials: A
authors.lastname: Fyles
authors.forename: Melania
authors.initials: M
authors.lastname: Pintilie
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D017533:Marital Status; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*