title: High versus low-dose rate brachytherapy for cervical cancer.
abstract: OBJECTIVE
  Brachytherapy plays an important role in the treatment of cervical cancer. While small trials have shown comparable survival outcomes between high (HDR) and low-dose rate (LDR) brachytherapy, little data is available in the US. We examined the utilization of HDR brachytherapy and analyzed the impact of type of brachytherapy on survival for cervical cancer.
  
  
  METHODS
  Women with stages IB2-IVA cervical cancer treated with primary (external beam and brachytherapy) radiotherapy between 2003-2011 and recorded in the National Cancer Database (NCDB) were analyzed. Generalized linear mixed models and Cox proportional hazards regression were used to examine predictors of HDR brachytherapy use and the association between HDR use and survival.
  
  
  RESULTS
  A total of 10,564 women including 2681 (25.4%) who received LDR and 7883 (74.6%) that received HDR were identified. Use of HDR increased from 50.2% in 2003 to 83.9% in 2011 (P<0.0001). In a multivariable model, year of diagnosis was the strongest predictor of use of HDR. While patients in the Northeast were more likely to receive HDR therapy, there were no other clinical or socioeconomic characteristics associated with receipt of HDR. In a multivariable Cox model, survival was similar between the HDR and LDR groups (HR=0.93; 95% CI 0.83-1.03). Similar findings were noted in analyses stratified by stage and histology. Kaplan-Meier analyses demonstrated no difference in survival based on type of brachytherapy for stage IIB (P=0.68), IIIB (P=0.17), or IVA (P=0.16) tumors.
  
  
  CONCLUSIONS
  The use of HDR therapy has increased rapidly. Overall survival is similar for LDR and HDR brachytherapy.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.
authors.forename: Sonali S
authors.initials: SS
authors.lastname: Patankar
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.affiliation: Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
authors.forename: Israel
authors.initials: I
authors.lastname: Deutsch
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
authors.forename: June Y
authors.initials: JY
authors.lastname: Hou
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, United States.
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.
authors.forename: Yongmei
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States. Electronic address: jw2459@columbia.edu.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods* / Q000706:statistics & numerical data; D002277:Carcinoma / Q000401:mortality / Q000532:radiotherapy*; D016208:Databases, Factual; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D016896:Treatment Outcome; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy*
keywords: Brachytherapy; Cervical cancer; High-dose rate; Intracavitary; Low-dose rate; Radiation