Disparities and Health Access in Brachytherapy Boost Administration in Woman With Locally Advanced Cervical Cancer.

Abstract

PURPOSE/OBJECTIVE(S)\nExternal beam radiation therapy (EBRT) and brachytherapy boost should be completed in less than eight weeks, as better local tumor control and survival can be expected with relatively shorter treatment courses. We analyzed our institutional experience in total treatment time (TTT) with high dose rate (HDR) brachytherapy boost for patients with locally advanced cervical cancer who received the EBRT portion of their treatment in an outside facility (OF) and treatment outcomes.\n\n\nMATERIALS/METHODS\nA single-institution, retrospective IRB-approved study was performed using 101 women with FIGO Stage IB2-IVA cervical cancer treated from 2010 to 2019. Women treated with definitive chemoradiation either in our institution or in an OF followed by HDR brachytherapy boost in our institution were enrolled. TTT was defined as total treatment time in weeks (wk) from initiation of EBRT to the end of HDR brachytherapy. Patients were treated with EBRT to the pelvis only or extended field (EFRT) with or without nodal boosts.\n\n\nRESULTS\n101 patients were included in this study. 95% of patients treated at our institution were stage IIB or higher compared to 70% for patients treated at an OF (P < 0.001). TTT was significantly longer for patients who received EBRT at an OF and HDR brachytherapy in our institution compared to patients who received both EBRT and HDR brachytherapy in our institution (9.1 wk vs 7.1 wk, P < 0.05). Increased TTT was associated with inferior mean progression free survival (121 wk vs. 90 wk), although it did not reach significance (P\u202f=\u202f0.19). Some of the documented delayed reasons were referral patterns, socioeconomic burden or functional status. There was no difference in PFS between the two cohorts. However, when only patients with IIB or higher disease were included, there was a trend towards an increase in mean PFS favoring treatment at our institution (113 wk vs 75 wk, P\u202f=\u202f0.1). 77% of patients had HDR boost delayed more than 7 days after completion of EBRT when treated at an OF in comparison to 18% of the patients in our institution (P < 0.01). Of the women with positive lymph nodes (FIGO Stage IIIC1 or C2) treated at an OF, only 19% received nodal irradiation boost compared to 89% in our institution. All patients with FIGO Stage IIIC2 received EFRT in our institution.\n\n\nCONCLUSION\nWomen with locally advanced cervical cancer in rural areas are less likely to complete the total radiation treatment in less than eight weeks due to socioeconomic disparities, health access or inappropriate referral patterns. This increased delay translated to a trend in survival when examining women with higher stage cancer. Improving access to brachytherapy and external beam radiotherapy at specialized high volume referral centers may improve patient outcomes.