Changing Landscape of Radiotherapy for Advanced Cervical Cancer with a Focus on Interstitial Brachytherapy: A Canadian Practice Patterns Survey.

Abstract

PURPOSE\nTo document the evolution of radical radiotherapy and interstitial brachytherapy (ISBT) utilization practice patterns across Canada, including use of imaging, technical details, usage of anesthesia/analgesia, and to compare advanced (AC) versus non-advanced (nAC) brachytherapy (BT) center practices.\n\n\nMATERIALS & METHODS\nAll Canadian centers with BT services were identified. One gynecology radiation oncologist per center was sent a 64-item questionnaire regarding the center s practice for cervical cancer (CC) patients. Centers were categorized based on availability of advanced BT expertise (AC) versus those referring patients to other centers for advanced BT techniques (nAC). Aggregate responses are reported and compared with practice patterns identified in our previous survey. Descriptive statistics were used to summarize data and Fisher s exact test, Fisher-Freeman-Halton or Mann-Whitney-Wilcox test was used for comparisons.\n\n\nRESULTS\nThirty-seven of 38 respondents completed the survey (response rate: 97.4%).\xa0Compared to 2015, there has been an increase in utilization of MRI as the sole imaging modality for BT planning, 3/26 (11%) versus 12/37 (32%), (p=0.03). The number of centers with ability to perform ISBT increased in 2020 compared to 2015 (26/37 (70%) vs 13/26 (50%), p=0.710); this trend is likely due to an increase in use of hybrid (Vienna, Utrecht, Venezia) applicators [36% (2015) versus 84% (2020) (p=0.175)]. Fifteen (40%) centers had the ability to perform perineal-ISBT (P-ISBT). Sixteen and 21 centers were identified as AC and nAC, respectively. All 16 AC centers had the ability to perform ISBT compared to only 10 nAC centers (p<0.001). A higher proportion of AC centers had fellowship-trained radiation oncologists performing brachytherapy, compared to nAC centers (94% versus 14%, p<0.001). In terms of anesthesia, conscious sedation was the only available choice at low patient volume centers (8/37, 21%) performing intracavitary BT only. Those performing ISBT had choice of general, spinal and epidural anesthesia.\n\n\nCONCLUSIONS\nIn Canada, high quality, modern management radiotherapy practices are consistently offered to patients with CC. There is a trend towards increased utilization of ISBT. Accumulation of evidence toward the use of ISBT, increased utilization of high-quality imaging modalities such as MRI, and availability of hybrid applicators are potential contributors for this upward trend.