Although cervical cancer rates in the United States have dropped significantly due to improved detection of pre-cancerous lesions and the advent of the human papillomavirus vaccine, it is still the fourth most common cancer in women. The American Cancer Society estimates that nearly 14,000 women will be diagnosed with cervical cancer in 2020 and that almost 4,300 will die from the disease. While the 5-year survival rate for localized cervical cancer is 92%, the rate drops to 56% once the cancer has spread to regional lymph nodes and to 17% once it has spread to other organs.

Given the poor survival rates for women with advanced cervical cancer, new treatment regimens are needed. Although today’s standard of care for advanced cervical cancer is chemotherapy in combination with external beam radiation therapy (EBRT), a growing body of evidence demonstrates that brachytherapy administered after chemo/EBRT improves overall survival. One study found a 12% increase in 4-year survival in women who received a brachytherapy boost compared with patients receiving EBRT alone, and other studies have shown that 3D image-guided brachytherapy using interstitial needles that expand the treatment area and conform to the shape of the tumor is associated with improved clinical outcomes, especially for patients with larger tumors.

Unfortunately, despite the clear benefits of adding brachytherapy to the treatment regimen for advanced cervical cancer, there is a growing trend in the United States not to use it. Although the reason for this trend is still being evaluated, potential contributing factors include inadequate physician training and experience in the use of brachytherapy for cervical cancer; lack of reimbursement for the procedure, which is a disincentive to performing a labor-intensive procedure, such as brachytherapy; and the increasing number of cancer patients who receive care at out-patient centers that are not equipped to perform brachytherapy procedures.

As physicians, it is incumbent upon us to do everything in our power to improve our patients’ care and outcomes. In the treatment of cervical cancer, this requires advocating for and contributing to improved training on brachytherapy procedures, supporting policies that align reimbursement with outcomes, and referring patients to care centers that are able to provide a complete suite of cancer therapies, including brachytherapy. New innovations in brachytherapy—including new gynecologic applicators that simplify the use of brachytherapy to treat advanced cervical cancers in which the tumor has spread outside the cervix—may also help to reverse the alarming trend toward decreased use of a potentially lifesaving therapy. The data tell us what works. It’s our job as physicians to do what is best for our patients.

References

About Cervical Cancer. Key Statistics for Cervical Cancer. American Cancer Society. Revised January 8, 2020. Available at: https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html

About Cervical Cancer. Survival Rates for Cervical Cancer. American Cancer Society. Revised January 3, 2020. Available at: https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/survival.htm

Han K et al. Int J Radiation Oncol Biol Phys 2013; 87:111-119.

Sturdza A, Pötter R, Fokdal LU, et al. Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Radiother Oncol. 2016;120(3):428-433.

Fokdal L, Sturdza A, Mazeron R, et al. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study. Radiother Oncol. 2016;120(3):434-440.

Mazeron R, Fokdal LU, Kirchheiner K, et al. Dose-volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: Results from the prospective multicenter EMBRACE study. Radiother Oncol. 2016;120(3):412-419.