title: Patterns of care with brachytherapy for cervical cancer.
abstract: OBJECTIVE
  Concurrent chemotherapy with external beam radiotherapy (EBRT) and brachytherapy (BT) is critical to the curative treatment of locally advanced cervical cancer. Patterns of care and the use of EBRT and BT for locally advanced cervical cancer in the United States were analyzed with an emphasis on regional variation across the United States.
  
  
  METHODS
  A retrospective analysis was performed using the Surveillance, Epidemiology, and End Results Program database from 1988 to 2010 to identify women with locally advanced cervical carcinoma treated with definitive radiotherapy.
  
  
  RESULTS
  Twelve thousand three hundred women were identified who met the inclusion criteria. From 1988 to 2010, percent use of EBRT and BT decreased from 68% to 45%; specifically, between 1988 and 2000, there was a decrease of 12% (P = 0.0003), and between 2000 and 2010, there was another decrease of 11% (P < 0.0001). When examined individually, 15 of the 16 registries displayed a decline in use of EBRT and BT with a significant decrease in 11 of the registries. No registry displayed an increased use of EBRT and BT, but the use of EBRT alone increased from 1988 to 2000 by 8% (P = 0.0055) and from 2000 to 2010 by 6% (P = 0.0095).
  
  
  CONCLUSIONS
  Combination of EBRT and BT for locally advanced cervical cancer continues to decline, despite guidelines indicating the appropriateness of BT. This decline was seen for most regions across the United States, with a concomitant rise in the use of EBRT. EBRT alone is an inferior therapy and must be used in conjunction with BT to realize maximal patient benefit.
authors.affiliation: *Department of Radiation Oncology, †Biostatistics, and ‡Cancer Control & Population Sciences, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT.
authors.forename: Hilary P
authors.initials: HP
authors.lastname: Bagshaw
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Pappas
authors.forename: Deanna L
authors.initials: DL
authors.lastname: Kepka
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Tward
authors.forename: David K
authors.initials: DK
authors.lastname: Gaffney
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy*; D000236:Adenoma / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000706:statistics & numerical data*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*