title: Are we appropriately selecting therapy for patients with cervical cancer? Longitudinal patterns-of-care analysis for stage IB-IIB cervical cancer.
abstract: OBJECTIVE
  We performed a patterns-of-care analysis evaluating the effects of newer technology and recent research findings on treatment decisions over 26 years to determine whether patients with cervical cancer are being appropriately selected for treatment to optimize the therapeutic ratio.
  
  
  METHODS
  A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results (SEER) program from 1983 to 2009. We identified 10,933 women with stage IB-IIB cervical carcinoma.
  
  
  RESULTS
  Of the 10,933 subjects identified, 40.1% received surgery, 26.8% received radiation (RT), and 33.1% received surgery plus RT. RT use increased after 2000 compared to prior to 2000, with a corresponding decrease in surgery and surgery plus RT. Among patients with risk factors including tumor size >4 cm, positive parametria, and positive lymph nodes, declining use of surgery plus RT was observed. However, 23% of patients with tumors >4 cm, 20% of patients with positive parametria, and 55% of node-positive patients continued to receive surgery plus RT as of 2009. Factors associated with increased use of surgery plus RT included patient age <50 and node-positive status.
  
  
  CONCLUSIONS
  In this largest patterns-of-care analysis to date for patients with locally advanced cervical cancer, we found a substantial proportion of patients continue to undergo surgery followed by radiation, despite randomized data supporting the use of definitive radiation therapy, with lower morbidity than surgery and radiation.
authors.affiliation: Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado. Electronic address: Julie.A2.Carlson@ucdenver.edu.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Carlson
authors.affiliation: Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado.
authors.forename: Chad
authors.initials: C
authors.lastname: Rusthoven
authors.affiliation: Colorado Biostatistics Consortium, Aurora, Colorado.
authors.forename: Peter E
authors.initials: PE
authors.lastname: DeWitt
authors.affiliation: Department of Obstetrics/Gynecology, Division of Gynecologic Oncology, University of Colorado Denver, Aurora, Colorado.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Davidson
authors.affiliation: Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado.
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Schefter
authors.affiliation: Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Fisher
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012044:Regression Analysis; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*