Are We Appropriately Selecting Therapy For Patients With Cervical Cancer? Longitudinal Patterns-of-Care Analysis for Stage IB-IIB Cervical Cancer

被引:18
作者
Carlson, Julie A. [1 ]
Rusthoven, Chad [1 ]
DeWitt, Peter E. [2 ]
Davidson, Susan A. [3 ]
Schefter, Tracey E. [1 ]
Fisher, Christine M. [1 ]
机构
[1] Univ Colorado Denver, Dept Radiat Oncol, Aurora, CO 80045 USA
[2] Colorado Biostat Consortium, Aurora, CO USA
[3] Univ Colorado Denver, Dept Obstet Gynecol, Div Gynecol Oncol, Aurora, CO 80045 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2014年 / 90卷 / 04期
关键词
PELVIC RADIATION-THERAPY; NODE-POSITIVE PATIENTS; RADICAL HYSTERECTOMY; CONCURRENT CHEMOTHERAPY; RANDOMIZED-TRIAL; CARCINOMA; RADIOTHERAPY; SURGERY;
D O I
10.1016/j.ijrobp.2014.07.034
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: We performed a patterns-of-care analysis evaluating the effects of newer technology and recent research findings on treatment decisions over 26 years to determine whether patients with cervical cancer are being appropriately selected for treatment to optimize the therapeutic ratio. Methods and Materials: A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results (SEER) program from 1983 to 2009. We identified 10,933 women with stage IB-IIB cervical carcinoma. Results: Of the 10,933 subjects identified, 40.1% received surgery, 26.8% received radiation (RT), and 33.1% received surgery plus RT. RT use increased after 2000 compared to prior to 2000, with a corresponding decrease in surgery and surgery plus RT. Among patients with risk factors including tumor size >4 cm, positive parametria, and positive lymph nodes, declining use of surgery plus RT was observed. However, 23% of patients with tumors >4 cm, 20% of patients with positive parametria, and 55% of node-positive patients continued to receive surgery plus RT as of 2009. Factors associated with increased use of surgery plus RT included patient age <50 and nodepositive status. Conclusions: In this largest patterns-of-care analysis to date for patients with locally advanced cervical cancer, we found a substantial proportion of patients continue to undergo surgery followed by radiation, despite randomized data supporting the use of definitive radiation therapy, with lower morbidity than surgery and radiation. (C) 2014 Elsevier Inc.
引用
收藏
页码:786 / 793
页数:8
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