Journal ArticleDOI
Trends in the Utilization of Brachytherapy in Cervical Cancer in the United States
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TLDR
Brachytherapy use is independently associated with significantly higher CSS and OS and should be implemented in all feasible cases and significant geographic disparities in the delivery of brachyther therapy in the United States are revealed.Abstract:
Purpose To determine the trends in brachytherapy use in cervical cancer in the United States and to identify factors and survival benefits associated with brachytherapy treatment. Methods and Materials Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 7359 patients with stages IB2-IVA cervical cancer treated with external beam radiation therapy (EBRT) between 1988 and 2009. Propensity score matching was used to adjust for differences between patients who received brachytherapy and those who did not from 2000 onward (after the National Cancer Institute alert recommending concurrent chemotherapy). Results Sixty-three percent of the 7359 women received brachytherapy in combination with EBRT, and 37% received EBRT alone. The brachytherapy utilization rate has decreased from 83% in 1988 to 58% in 2009 ( P .001), with a sharp decline of 23% in 2003 to 43%. Factors associated with higher odds of brachytherapy use include younger age, married (vs single) patients, earlier years of diagnosis, earlier stage and certain SEER regions. In the propensity score-matched cohort, brachytherapy treatment was associated with higher 4-year cause-specific survival (CSS; 64.3% vs 51.5%, P .001) and overall survival (OS; 58.2% vs 46.2%, P .001). Brachytherapy treatment was independently associated with better CSS (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.57-0.71), and OS (HR 0.66; 95% CI, 0.60 to 0.74). Conclusions This population-based analysis reveals a concerning decline in brachytherapy utilization and significant geographic disparities in the delivery of brachytherapy in the United States. Brachytherapy use is independently associated with significantly higher CSS and OS and should be implemented in all feasible cases.read more
Citations
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Journal ArticleDOI
Magnetic Resonance–Guided Radiation Therapy to Boost Cervical Cancer When Brachytherapy Is Not Available: A Case Report
TL;DR: The case of a 66-year-old female with a large bilobular cervical stump cancer, treated with external beam radiation therapy to pelvis with concomitant chemotherapy followed by magnetic resonance guided radiation therapy (MRgRT) boost is reported.
Journal ArticleDOI
Curiethérapie : quand les indications dépassent l’offre de soins
Sophie Espenel,Elaine Johanna Limkin,M.-A. Garcia,Julien Langrand-Escure,Alexis Vallard,Cyrus Chargari,Nicolas Magné +6 more
TL;DR: L’incidence croissante des indications de curietherapie, leurs niveaux de preuve et leurs rapports benefice-risque grandissants, imposent d’affronter les defis de formation aux techniques of curiethersapie et d‘organisation of son offre sur le territoire.
Journal ArticleDOI
Stereotactic body radiotherapy boost in patients with cervical cancer
TL;DR: SBRT is an alternative option in cases with small residual disease where BRT cannot be applied, and it provides a basis for a prospective randomised study.
Journal ArticleDOI
Radiation Oncology Management of Stage I–III Cervix Cancer
TL;DR: Signals for radiotherapy in the management of nonmetastatic cervix cancer are addressed and various radiotherapy techniques are reviewed, with a heavy focus on brachytherapy.
Journal ArticleDOI
Comparing efficacy of high-dose rate brachytherapy versus helical tomotherapy in the treatment of cervical cancer.
TL;DR: HT boost treatment showed comparable disease outcomes with those observed with conventional BT in patients with advanced cervical cancer, suggesting that HT could be a complementary boost protocol as a single modality or hybrid with BT in selected patients.
References
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Book
Applied Logistic Regression
David W. Hosmer,Stanley Lemeshow +1 more
TL;DR: Hosmer and Lemeshow as discussed by the authors provide an accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets.
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Journal ArticleDOI
Propensity score methods for bias reduction in the comparison of a treatment to a non‐randomized control group
TL;DR: The propensity score, defined as the conditional probability of being treated given the covariates, can be used to balance the variance of covariates in the two groups, and therefore reduce bias as mentioned in this paper.
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