Eakin Adam, Wairiri Loise, Stadtlander William, Bruegl Amanda, Emerson Jenna, Williamson Casey, Kahn Jenna
Oregon Health and Science University, Portland, OR.
Oregon Health and Science University, Portland, OR.
Brachytherapy. 2023 Jul-Aug;22(4):461-467. doi: 10.1016/j.brachy.2023.02.003. Epub 2023 Apr 2.
The standard of care for locally advanced cervical cancer is concurrent chemotherapy and external beam radiation therapy (EBRT) followed by a brachytherapy boost. Some studies show a decreased usage of brachytherapy in cervical cancer patients despite the standard of care and known survival advantage. This study aims to characterize the utilization of brachytherapy in Oregon and identify where disparities in treatment may exist.
The Oregon State Cancer Registry database was used to identify patients diagnosed with FIGO Stage IB2-IVB cervical cancer between 2007 and 2016. Patients who received initial EBRT were categorized by whether they received brachytherapy boost or not. Age at diagnosis, county of patient residence, rural-urban status of the county, race/ethnicity, and insurance payer were studied using multivariable logistic regression to identify possible underserved populations. Survival data was compared using a Cox proportional hazard survival model.
401 patients who received primary EBRT for FIGO stage IB2-IVB cervical cancer were identified in the 10-year span. Breakdown by stage is: 16% stage IB2, 23.9% stage II, 37.4% stage III, and 22.7% stage IV. Of those, 154 (38.4%) received brachytherapy boost treatment, 75 (18.7%) received a different boost modality, and 42.9% received no boost. Stage IV (p = 0.001) and uninsured patients (p = 0.04) were significantly less likely to receive brachytherapy. Older age was also associated with decreased brachytherapy usage, as each additional year of life decreased brachytherapy receipt by 1.8% (p = 0.04). Native American and Pacific Islander patients were the only group significantly more likely to receive brachytherapy (p=0.003). There was no significant difference in the rate of brachytherapy boost identified based on urban/rural status of the county (p = 0.63 to 0.69), other racial/ethnic categories (p = 0.66 to 0.80), or among the other stages (p=0.45 to 0.63). In Cox proportional hazard survival analysis, patients that received brachytherapy showed a 42% reduction in risk of cancer specific mortality, though this did not reach the predetermined level of statistical significance (p = 0.057).
The brachytherapy boost rate among locally advanced cervical cancer patients was 38.4%. The data also indicated a likely reduction in cancer specific mortality in patients receiving brachytherapy. Older patients, stage IV patients, and uninsured patients were less likely to receive brachytherapy. Given the low overall brachytherapy usage, these data indicate access and delivery of brachytherapy care needs to be improved across the state. The increased brachytherapy use in the American Indian and Pacific Islander patient population should be further studied to identify facilitators to treatment completion and potentially extrapolate to other groups.
局部晚期宫颈癌的标准治疗方案是同步化疗及外照射放疗（EBRT），随后进行近距离放疗加强剂量。一些研究表明，尽管有标准治疗方案且已知近距离放疗具有生存优势，但宫颈癌患者中近距离放疗的使用仍有所减少。本研究旨在描述俄勒冈州近距离放疗的使用情况，并确定可能存在治疗差异的地方。
利用俄勒冈州癌症登记数据库确定2007年至2016年间被诊断为国际妇产科联盟（FIGO）IB2-IVB期宫颈癌的患者。接受初始EBRT的患者根据是否接受近距离放疗加强剂量进行分类。使用多变量逻辑回归研究诊断时的年龄、患者居住县、县的城乡状况、种族/民族和保险支付方，以确定可能未得到充分服务的人群。使用Cox比例风险生存模型比较生存数据。
在这10年期间，共确定了401例接受FIGO IB2-IVB期宫颈癌原发性EBRT的患者。各期分布为：IB2期占16%，II期占23.9%，III期占37.4%，IV期占22.7%。其中，154例（38.4%）接受了近距离放疗加强治疗，75例（18.7%）接受了不同的加强治疗方式，42.9%未接受加强治疗。IV期患者（p = 0.001）和未参保患者（p = 0.04）接受近距离放疗的可能性显著降低。年龄较大也与近距离放疗使用减少有关，每增加一岁，接受近距离放疗的可能性降低1.8%（p = 0.04）。美国原住民和太平洋岛民患者是唯一接受近距离放疗可能性显著更高的群体（p = 0.003）。根据县的城乡状况（p = 0.63至0.69）、其他种族/民族类别（p = 0.66至0.80）或其他分期（p = 0.45至0.63）确定的近距离放疗加强治疗率无显著差异。在Cox比例风险生存分析中，接受近距离放疗的患者癌症特异性死亡风险降低了42%，尽管这未达到预定的统计学显著性水平（p = 0.057）。
局部晚期宫颈癌患者的近距离放疗加强治疗率为38.4%。数据还表明接受近距离放疗的患者癌症特异性死亡可能减少。老年患者、IV期患者和未参保患者接受近距离放疗的可能性较小。鉴于总体近距离放疗使用率较低，这些数据表明该州各地的近距离放疗护理的可及性和提供情况需要改善。美国印第安人和太平洋岛民患者群体中近距离放疗使用的增加应进一步研究，以确定促进治疗完成的因素，并可能推广到其他群体。
