title: National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements.
abstract: OBJECTIVE
  To utilize the National Cancer Data Base to evaluate trends in brachytherapy and alternative radiation therapy utilization in the treatment of cervical cancer, to identify associations with outcomes between the various radiation therapy modalities.
  
  
  METHODS
  Patients with International Federation of Gynecology and Obstetrics stage IIB-IVA cervical cancer in the National Cancer Data Base who received treatment from January 2004 to December 2011 were analyzed. Overall survival was estimated by the Kaplan-Meier method. Univariate and multivariable analyses were performed to identify factors associated with type of boost radiation modality used and its impact on survival.
  
  
  RESULTS
  A total of 7654 patients had information regarding boost modality. A predominant proportion of patients were Caucasian (76.2%), had stage IIIB (48.9%) disease with squamous (82.0%) histology, were treated at academic/research centers (47.7%) in the South (34.8%), and lived 0 to 5 miles (27.9%) from the treating facility. A majority received brachytherapy (90.3%). From 2004 to 2011, brachytherapy use decreased from 96.7% to 86.1%, whereas intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) use increased from 3.3% to 13.9% in the same period (P<.01). Factors associated with decreased brachytherapy utilization included older age, stage IVA disease, smaller tumor size, later year of diagnosis, lower-volume treatment centers, and facility type. After controlling for significant factors from survival analyses, IMRT or SBRT boost resulted in inferior overall survival (hazard ratio, 1.86; 95% confidence interval, 1.35-2.55; P<.01) as compared with brachytherapy. In fact, the survival detriment associated with IMRT or SBRT boost was stronger than that associated with excluding chemotherapy (hazard ratio, 1.61' 95% confidence interval, 1.27-2.04' P<.01).
  
  
  CONCLUSIONS
  Consolidation brachytherapy is a critical treatment component for locally advanced cervical cancer; however, there has been declining utilization of brachytherapy. Increased use of IMRT and SBRT boost coupled with increased mortality risk should raise concerns about utilizing these approaches over brachytherapy.
authors.affiliation: Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Beant S
authors.initials: BS
authors.lastname: Gill
authors.affiliation: Department of Gynecologic Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jeff F
authors.initials: JF
authors.lastname: Lin
authors.affiliation: Department of Gynecologic Oncology, Western Pennsylvania Hospital, Pittsburgh, Pennsylvania.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Krivak
authors.affiliation: Department of Gynecologic Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Paniti
authors.initials: P
authors.lastname: Sukumvanich
authors.affiliation: Department of Gynecologic Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Robin A
authors.initials: RA
authors.lastname: Laskey
authors.affiliation: Department of Gynecologic Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Malcolm S
authors.initials: MS
authors.lastname: Ross
authors.affiliation: Department of Gynecologic Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Lesnock
authors.affiliation: Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: beriwals@upmc.edu.
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001918:Brachytherapy / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D002173:Cancer Care Facilities / Q000600:supply & distribution; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D044469:Racial Groups / Q000145:classification / Q000706:statistics & numerical data; D016634:Radiosurgery / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*