Brachytherapy improves survival in advanced cervical cancer, but racial disparities remain

One study presented at Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer demonstrated the survival benefits of brachytherapy for treating advanced cervical cancer.

However, a second presentation highlighted the apparent underutilization of this approach, particularly among black women.

Standard-of-care treatment with external beam radiation therapy (EBRT) plus brachytherapy and concurrent chemotherapy within 8 weeks significantly prolonged survival compared with chemoradiation alone among women with advanced cervical cancer, according to study results presented by Travis-Riley K. Korenaga, MD, resident physician at University of California, San Francisco.

Women who received a brachytherapy boost beyond the 8-week time frame recommended by the Gynecologic Oncologic Group and the Radiation Therapy Oncology Group achieved longer OS than women who received external beam radiation therapy only, results showed.

However, although brachytherapy has been shown to improve outcomes in advanced cervical cancer, it appears to be underutilized.

Black women —who have the highest cervical cancer mortality — are significantly less likely than white women to receive the boost as part of treatment, according to study results presented by Stephanie Alimena, MD, resident physician at Brigham and Women’s Hospital and Massachusetts General Hospital, and Martin T.H. King, MD, PhD, director of brachytherapy clinical operations at Dana-Farber Cancer Institute and instructor in radiation oncology at Harvard Medical School.

‘A very small percentage’

Korenaga and colleagues reviewed the National Cancer Database to identify 10,598 women with stage II to IVA locally advanced cervical cancer diagnosed between 2005 and 2014.

All women received EBRT and with concurrent chemotherapy as their primary treatment.

The majority (73.5%; n = 7,786) also had a brachytherapy boost. Only 3,882 (36.6%) women received the boost within the recommended 8 weeks.

“That’s a very small percentage, [but] it’s not a huge departure from what we have seen in the past,” Korenaga told HemOnc Today.

OS served as the study’s primary outcome. Researchers also assessed the impact of socioeconomic and clinical variables on receipt of standard-of-care treatment.

Results showed that women who received standard-of-care treatment achieved significantly longer median OS (121.3 months) than women in all other groups.

Women who received EBRT and brachytherapy beyond 8 weeks achieved longer median OS (93.6 months) than those who had EBRT only within 8 weeks (45.3 months) or EBRT only beyond 8 weeks (51 months).

“Receiving any amount of brachytherapy, even if it extends treatment duration beyond the recommended 8 weeks, does show a survival benefit,” Korenaga told HemOnc Today. “For patients who are trying to decide whether they should complete treatment without brachytherapy in an early time frame, or add some brachytherapy that may extend beyond the recommended time frame, the latter would be preferable.”

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Korenaga and colleagues noted that some women appeared less likely than others to receive the standard-of-care regimen. These included women who were non-Hispanic black, women who underwent radiation at more than one location, and those with low incomes, no insurance or government insurance, or higher disease stage.

Treatment disparities

Alimena, King and colleagues conducted a retrospective cohort study of 17,143 women with locally advanced cervical cancer.

The researchers determined black women were less likely than white women to undergo brachytherapy (OR = 0.86; 95% CI, 0.78-0.95). Black women also demonstrated the greatest risk for all-cause mortality (median survival, 53.4 months) and were significantly less likely to receive a brachytherapy boost within the recommended time frame (OR = 1.12; 95% CI, 1.03-1.22). Women aged older than 70 years, those who were uninsured or publicly insured, and those with significant comorbidities also were less likely to receive the boost within the recommended time frame.

“Black patients were less likely to receive brachytherapy [than] nonblack patients, and ... overall, black patients had worse outcomes than white patients,” King told HemOnc Today. “However, when we stratified our analysis by whether black patients received brachytherapy, we found that black patients who received maximal treatment with brachytherapy did as well as white patients. So, what this tells us is that a lot of this disparity in survival outcomes is related to undertreatment.” – by Jennifer Byrne

Reference:

Alimena S, et al. Abstract 11. Presented at: Society of Gynecologic Oncology Annual Meeting on Women’s Cancer; March 16-19, 2019; Honolulu.

Korenaga TRK, et al. Abstract 10. Presented at: Society of Gynecologic Oncology Annual Meeting on Women’s Cancer; March 16-19, 2019; Honolulu.

Disclosure s : HemOnc Today could not confirm the authors’ relevant financial disclosures at the time of reporting.