Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California

Mayadev, Jyoti; Klapheke, Amy; Yashar, Catheryn M.; Hsu, I‐Chow; Kamrava, Mitchell; Mundt, Arno J.; Mell, Loren K.; Einck, John; Benedict, Stanley H; Valicenti, Richard K.; Cress, Rosemary D.

doi:10.1016/j.ygyno.2018.04.563

Cited by 38 publications

(31 citation statements)

References 30 publications

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“…Image-guided BT (IGBT) is an integral component of primary RT for uterine cervical cancer contributing to improved pelvic control and survival compared to chemoradiation therapy (CRT) by sole EBRT [6,7,23]. Against this background, quality of life issues has gained increasing importance for treatment decision making, with BT having proved next to high efficacy also low morbidity [23].…”

Section: Discussionmentioning

confidence: 99%

“…Brachytherapy (BT) plays an evidence-based role in the definitive radiotherapy (RT) of uterine cervical cancer [1,2,3,4,5], with its impact being reflected in the direct correlation between its utilization and improvement in survival [6,7]. Furthermore, the introduction of image-guided adaptive brachytherapy (IGABT) facilitated the generation of clinical knowledge concerning the optimal dose coverage of the high-risk clinical target volume (HR-CTV), i.e.…”

Section: Purposementioning

confidence: 99%

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Hyaluronic gel injection into the vesicovaginal septum for high-dose-rate brachytherapy of uterine cervical cancer: an effective approach for bladder dose reduction

Murakami¹,

Shima²,

Kashihara³

et al. 2019

jcb

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PurposeThe purpose of this study was to report our initial experience of hyaluronic acid gel injection (HGI) in the vesicovaginal septum (VVS) for bladder dose reduction in brachytherapy (BT) for uterine cervical carcinoma.Material and methodsBetween September 2016 and May 2018, 15 uterine cervical cancer patients received HGI in the VVS as a part of their definitive radiotherapy (RT) treatment consisting of external beam radiation therapy (EBRT) with additional BT. Of those, 9 patients received BT both with and without HGI, and remaining 6 patients were excluded because these 6 patients received HGI in the VVS for all BT fractions. All 9 patients received HGI in the rectovaginal septum. For these patients, the dosimetric parameters bladder D2cc, HR-CTV D90, and rectum D2cc were selected, and two groups were generated (BT with vs. without HGI in the VVS) for dosimetric comparison.ResultsThe median cumulative EQD2 for HR-CTV, rectum D2cc, and bladder D2cc for the 9 patients were 73.3, 52.8, and 67.1, respectively. While no statistical difference could be detected for rectal dose reduction, bladder dose was significantly less in the group with HGI in the VVS compared to that without (449 cGy [range, 416-566, 1SD = 66.1] vs. 569 cGy [range, 449-647, 1SD = 59.5], p = 0.033), with no compromising of target coverage. Although it did not reach statistically significance, there was a trend toward better HR-CTV D90 in the group with HGI compared to that without HGI in the VVS (713 cGy vs. 706 cGy, p = 0.085). No severe bleeding, hematuria, bladder wall injury, or urethral injury requiring hospitalization was experienced in association with HGI in the VVS.ConclusionsHGI in the VVS can be performed safely and can effectively reduce the bladder dose in BT for uterine cervical cancer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

Hyaluronic gel injection into the vesicovaginal septum for high-dose-rate brachytherapy of uterine cervical cancer: an effective approach for bladder dose reduction

Murakami¹,

Shima²,

Kashihara³

et al. 2019

jcb

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“…A Surveillance, Epidemiology, and End Results (SEER) database analysis also identified the black race and the southern region of the US as manifesting higher mortality from cervical cancer [2]. Mayadev et al reported that AA patients had worse cancer-specific survival and overall survival compared to CA based on information from the California Cancer Registry [24]. On the other hand, Weragoda et al retrospectively analyzed cervical cancer patients from two large hospitals in the Southeastern US and reported that there were no racial differences in five-year survival between the races on multivariate analysis [25].…”

Section: Racial Disparities In Survivalmentioning

confidence: 99%

An Analysis of the Racial Disparities Among Cervical Cancer Patients Treated at an Academic Medical Center in the Southeastern United States

Thomas¹,

Gandhi²,

Bhanat³

et al. 2021

Cureus

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The purpose of this study was to identify racial disparities in treatment outcomes, if any, among patients with carcinoma of the cervix treated at a tertiary care institution in the state of Mississippi. Methods A retrospective review of patients with carcinoma of the cervix treated in the Department of Radiation Oncology at our institution between 2010 and 2018 was performed. Data regarding demographics, disease stage, treatments administered, and follow-up were collected. Patient outcomes, including median survival and overall survival, were analyzed using the Kaplan-Meier method. All analyses were performed using SPSS Statistics version 24 (IBM, Armonk, NY). Results Between January 2010 and December 2018, a total of 165 patients with carcinoma of the cervix were treated at our institution. We had a significantly higher proportion of African American (AA) compared to Caucasian American (CA) patients (59.4 vs. 36.4%; p=0.03). There was a significant difference in the disease stage at the time of presentation between AA and CA in that compared to AA women, a higher number of CA patients presented with locally advanced disease [Federation of Gynecology and Obstetrics (FIGO) stages IB2 to IVA] (78.6 vs. 86.7%; p<0.001). However, a higher number of AA patients presented with metastatic disease at diagnosis compared to CA women (13.3 vs. 8.3%; p<0.001). Regarding their treatment, 157 (95.2%) underwent definitive chemoradiotherapy, while three (1.8%) had definitive surgery followed by adjuvant radiation or chemoradiation, depending on the risk factors identified operatively. The treatment details of five patients were not available. The median follow-up and the median survival of the entire cohort were 16 months and 79 months, respectively. In our cohort, there was no significant difference in overall survival between AA and CA patients at either three years (80 vs. 68%; p=0.883) or five years (77 vs. 68%; p=0.883). As expected, patients with locally advanced disease showed a significantly better median survival of 79 months compared to only 11 months for those with metastatic disease at their presentation (p<0.001). Conclusions Our study revealed that more AA women presented with metastatic disease compared to CA women. However, our analysis did not identify any racial disparities in the prognosis of the entire cohort.

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“…The underutilisation of brachytherapy in locally advanced cervical cancer globally is widely recognised and this effect is more pronounced in the elderly population with studies from North America reporting 20% of women between ages 70-79 and up to 60% of women >80 years old not receiving brachytherapy [18,19]. Analysis of the cooperative oncology group studies (COG) clinical trials consisting of the largest stage IVA patient populations in the literature reported, brachytherapy was not completed in 35% of patients !70 years versus 13% of patients <40 and this is despite the fact that these clinical trials are undertaken at large tertiary centres where brachytherapy programmes are well established [20].…”

Section: Gynaecological Cancermentioning

confidence: 99%

Practical brachytherapy solutions to an age-old quandary

Thiruthaneeswaran

Tharmalingam

Hoskin

2020

Technical Innovations & Patient Support in Radiation Oncolo

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Cancer is predominantly a disease of the elderly and as population life expectancy increases, so will the incidence of malignant disease. Elderly patients often have other comorbidities and social complexities, increasing the support required to safely deliver all treatment modalities. Brachytherapy is a relatively simple technique by which radiation therapy can be delivered. It offers dosimetric advantages through a highly conformal dose distribution thereby limiting radiation exposure to normal tissues reducing toxicity. Requiring fewer hospital visits, it also offers practical and logistical advantages to the elderly population and in many cases can be performed without the need for general anaesthesia. In tumour streams where brachytherapy forms part of the curative management, it should not be omitted in elderly patients who are medically fit for treatment. In the palliative setting, brachytherapy often offers an excellent means for achieving either local tumour and/or symptom control and should be actively considered in the therapeutic armamentarium of the oncologist in this context.

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Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California

Abstract: The utilization of BT in locally advanced cervical cancer was low at 45%, with a decrease in CSS and OS. Black patients and those in low SES had worse CSS. As we strive for outcome improvement in cervical cancer, we need to target increasing access and disparities for quality and value.

Cited by 38 publications

References 30 publications

Hyaluronic gel injection into the vesicovaginal septum for high-dose-rate brachytherapy of uterine cervical cancer: an effective approach for bladder dose reduction

Hyaluronic gel injection into the vesicovaginal septum for high-dose-rate brachytherapy of uterine cervical cancer: an effective approach for bladder dose reduction

An Analysis of the Racial Disparities Among Cervical Cancer Patients Treated at an Academic Medical Center in the Southeastern United States

Practical brachytherapy solutions to an age-old quandary

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