The Impact of Split Radiation Therapy on the Management of Locally Advanced Cervical Cancer in Central Virginia.

Background and objective Over the past few years, the complexity of brachytherapy (BT) has increased, and the practice patterns have shifted to distinguish high-volume centers as primary sites for these procedures. As a result, women with locally advanced cervical cancer (LACC) who are treated with external-beam radiotherapy (EBRT) at local centers are now more likely to be referred to higher-volume centers for their final BT boost. The impact of splitting radiotherapy sites on treatment adherence and outcomes is unclear. The purpose of this study was to compare the duration of treatment, recurrence, and survival between patients who received all radiotherapy at one center compared to those with split treatment. Methods A retrospective chart review was completed to identify women with stage IB-IVA cervical cancer treated with definitive radiation therapy (RT), including EBRT and BT between 2018 and 2023. Patients were grouped by location of EBRT, either at the primary institution (PI) or at an outside center. Patients were excluded if they had incomplete radiation therapy data, a missing address/zip code, metastatic disease, or a prior hysterectomy. Variables collected included demographics (age, race, ethnicity, insurance status, or geographic setting), disease and treatment characteristics, comorbidities, distance traveled to the RT sites, treatment duration, and survival status. Recurrence and survival analyses are limited to patients with at least one year of follow-up. Results Of the 66 women included in this study, 24 (36.3%) underwent EBRT at an outside location and were included in the split RT group. There was no significant difference between the two groups regarding age, disease characteristics, or comorbidities. The mean distance traveled to the PI was compared between the two groups and found to be statistically significant (p=0.001, t-test), with patients in the split group traveling a mean of 66.7 miles compared to 39.1 in the PI-only group. Likewise, the distance traveled to the EBRT site was significant, with women in the split group traveling a mean of only 13.6 miles compared to 39.1 (p<0.001, t-test). Of the 42 patients treated exclusively at the PI, 95.2% completed treatment within the recommended 56 days as opposed to 54.2% of the split RT patients (p<0.001, chi-squared test). Additionally, overall survival data were not significant; 80.8% of women in the PI-only group are reported to be alive without disease compared to 90.0% in the split group (p=1.000, chi-squared test). Conclusions In this study, we observed similar outcomes between LACC patients who had split their RT and those who received both EBRT and BT at the same high-volume PI. Yet, women who received RT at the PI exclusively had a shorter median duration of treatment and were more likely to complete treatment within the recommended timeline. Given the known relationship between treatment duration and patient outcomes in LACC, this study highlights the need to address factors that protract treatment duration to reduce potential disparities in care.