Impact of facility volume on therapy and survival for locally advanced cervical cancer.

Chemosensitizing radiation with brachytherapy is standard of care for treatment of locally advanced cervical cancer, an increasingly rare disease. Treatment facility volume has been correlated with outcome in many diseases. Treatment outcome and likelihood of receiving standard therapy in locally advanced cervical cancer based on facility volume were examined using a large national cancer database. The National Cancer Data Base was queried for patients with stage IIB - IIIB cervical cancer from 1/1998 through 12/2010. Facility volumes were tallied. Overall survival was estimated using Kaplan-Meier method. Univariate and multivariable analyses were performed to determine variables affecting survival, receiving standard therapy, and total duration of radiotherapy. We identified a total of 27,660 patients who were treated at 1361 facilities. Thirty of the facilities (2.2%) treated the highest quartile volume of patients (>9.4 patients annually) while 1072 facilities (78.8%) treated <2.4 patients annually. The median age of patients was 53, the majority were Caucasian, treated in a metropolitan area, and of squamous cell histology. Median survival of patients treated at lowest- and highest-volume centers were 42.3 months (95% CI 39.8-44.8) and 53.8 months (50.1-57.5), respectively (p < 0.001). The proportions of patients receiving brachytherapy and chemotherapy were 54.8% and 79.9%, respectively. On multivariable analysis, higher facility volume independently predicted improved survival (p = 0.022), increased likelihood of receiving brachytherapy (p < 0.0005) and chemotherapy (p = 0.013), and shorter time to radiotherapy completion (p < 0.0005). Patients with locally advanced cervical cancer treated at high volume centers are more likely to receive standard therapy, complete therapy sooner, and experience better survival.

Lin JF ，Berger JL ，Krivak TC ，Beriwal S ，Chan JK ，Sukumvanich P ，Monk BJ ，Richard SD ... -  《-》

National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements.

To utilize the National Cancer Data Base to evaluate trends in brachytherapy and alternative radiation therapy utilization in the treatment of cervical cancer, to identify associations with outcomes between the various radiation therapy modalities. Patients with International Federation of Gynecology and Obstetrics stage IIB-IVA cervical cancer in the National Cancer Data Base who received treatment from January 2004 to December 2011 were analyzed. Overall survival was estimated by the Kaplan-Meier method. Univariate and multivariable analyses were performed to identify factors associated with type of boost radiation modality used and its impact on survival. A total of 7654 patients had information regarding boost modality. A predominant proportion of patients were Caucasian (76.2%), had stage IIIB (48.9%) disease with squamous (82.0%) histology, were treated at academic/research centers (47.7%) in the South (34.8%), and lived 0 to 5 miles (27.9%) from the treating facility. A majority received brachytherapy (90.3%). From 2004 to 2011, brachytherapy use decreased from 96.7% to 86.1%, whereas intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) use increased from 3.3% to 13.9% in the same period (P<.01). Factors associated with decreased brachytherapy utilization included older age, stage IVA disease, smaller tumor size, later year of diagnosis, lower-volume treatment centers, and facility type. After controlling for significant factors from survival analyses, IMRT or SBRT boost resulted in inferior overall survival (hazard ratio, 1.86; 95% confidence interval, 1.35-2.55; P<.01) as compared with brachytherapy. In fact, the survival detriment associated with IMRT or SBRT boost was stronger than that associated with excluding chemotherapy (hazard ratio, 1.61' 95% confidence interval, 1.27-2.04' P<.01). Consolidation brachytherapy is a critical treatment component for locally advanced cervical cancer; however, there has been declining utilization of brachytherapy. Increased use of IMRT and SBRT boost coupled with increased mortality risk should raise concerns about utilizing these approaches over brachytherapy.

Gill BS ，Lin JF ，Krivak TC ，Sukumvanich P ，Laskey RA ，Ross MS ，Lesnock JL ，Beriwal S ... -  《-》

Patterns of brachytherapy practice for patients with carcinoma of the cervix (1996-1999): a patterns of care study.

Erickson B ，Eifel P ，Moughan J ，Rownd J ，Iarocci T ，Owen J ... -  《INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS》

Influence of treatment center and hospital volume on survival for locally advanced cervical cancer.

Procedural volume is associated with outcomes for many surgical interventions. Little is known about the association between volume and outcomes of radiation. We examined the association between treatment center and hospital volume and outcomes for women with locally advanced cervical cancer treated with radiation. Women with stage IIB-IVA cervical cancer treated with primary radiation from 1998 to 2011 and recorded in the National Cancer Database were examined. Hospital volume was estimated as the mean annualized volume, while center-specific effects on care were examined using a hospital-specific random effect. Multivariable regression models adjusted for metrics of treatment quality were used to estimate survival. 20,766 patients treated at 1115 hospitals were identified. The median follow-up was 24.2months while 5-year survival was 36.5% (95% CI, 35.6-37.4%). Higher hospital volume was associated with receipt of brachytherapy (P<0.05), but had no effect on use of chemotherapy. In a multivariable model accounting for clinical and demographic factors as well as quality of care, hospital volume was not associated with survival (P=0.25). The specific hospital in which patients received care was the strongest predictor of survival (P<0.0001) followed by stage, year of diagnosis and treatment quality (P<0.0001 for all). The hospital-specific effect on mortality expressed as a hazard ratio, ranged from 0.66 to 1.53 across hospitals. For locally advanced cervical cancer, hospital volume has a minimal impact on outcome; however, the specific center in which care is delivered is strongly associated with survival.

Wright JD ，Huang Y ，Ananth CV ，Tergas AI ，Duffy C ，Deutsch I ，Burke WM ，Hou JY ，Neugut AI ，Hershman DL ... -  《-》

Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer.

Pötter R ，Dimopoulos J ，Georg P ，Lang S ，Waldhäusl C ，Wachter-Gerstner N ，Weitmann H ，Reinthaller A ，Knocke TH ，Wachter S ，Kirisits C ... -  《RADIOTHERAPY AND ONCOLOGY》