Trends in Intensity Modulated Radiation Therapy Utilization for Definitive Treatment of Intact Cervical Cancer,...

The objective of this study was to identify temporal trends in intensity modulated radiation therapy (IMRT) use for patients with cervical cancer who received definitive chemoradiation.

Patients diagnosed with stage IB2-IVA cervical cancer between 2004 and 2019 and treated with definitive chemoradiation were identified in the National Cancer Database. The primary outcome of interest was the use of IMRT versus 3-dimensional conformal radiation therapy (3DCRT) over time. Wilcoxon rank-sum tests, chi-square tests, and multivariable logistic regression were used to identify factors associated with the receipt of IMRT.

Overall, 16,974 patients were included: 5388 (32%) received 3DCRT, and 11,586 (68%) received IMRT. IMRT use increased from 31% in 2004 to 75% in 2019 (P < .01). Clinical factors associated with increased IMRT use were stage III disease compared with stage I (odds ratio [OR], 1.3; CI, 1.0-1.5) and lymph node involvement (OR, 1.4; CI, 1.2-1.6). The demographic factors associated with increased IMRT receipt were treatment in the western US (OR, 1.5; CI, 1.2-1.8) and in the southern US (OR, 1.3; CI, 1.1-1.5) compared with the northeastern US, and living more than 50 miles from the treatment facility (OR, 1.2; CI, 1.0-1.5). Compared with White patients, Black patients (OR, 0.8; CI, 0.6-0.9) and patients receiving care at community hospitals compared with academic medical centers (OR, 0.7; CI, 0.6-0.7) were less likely to receive IMRT.

IMRT utilization for cervical cancer has increased over the last 15 years, especially for patients with advanced-stage disease or lymph node involvement. Understanding shifts in policy, demographic trends, and practice patterns may provide additional insight into the adoption of advanced technologies.