Radiotherapy use among locally advanced cervical cancer patients (LACC) in the United States community oncology setting.

Abstract

5523 Background: Brachytherapy with concurrent chemoradiation +/- pembrolizumab is the current standard of care for LACC. American Society for Radiation Oncology (ASTRO) recommends external beam radiation therapy (EBRT)+brachytherapy, and since 2020 has recommended intensity modulated radiation therapy (IMRT) over other forms of EBRT due to reduced toxicity risk. However, real-world evidence is needed to characterize patient outcomes based on the type of radiation received. Methods: Electronic medical record (EMR) data from The US Oncology Network identified adult LACC (FIGO 2018 Stage IB3-IVA) patients (pts) diagnosed between July 2018 – July 2022 and followed through June 2024. Pts were stratified by receipt of IMRT or Volumetric Modulated Arc Therapy (VMAT) and brachytherapy during the observation period. Patient characteristics and provider-documented progression were assessed descriptively. Results: This study included 250 LACC pts; 73 (29%) pts received IMRT or VMAT, 177 (71%) pts did not receive IMRT/VMAT; and 189 (76%) pts received brachytherapy. Overall, 61 pts (24%) received both IMRT or VMAT and brachytherapy. Among the 148 pts who were diagnosed in 2020 or later, 28% received IMRT or VMAT. Disease progression occurred among 33% of IMRT or VMAT pts and 26% of non IMRT or VMAT patients; progression was similar across brachytherapy and non-brachytherapy patients. Conclusions: Advanced radiation techniques such as IMRT or VMAT and brachytherapy are associated with improved outcomes for patients with LACC, yet their combined use only occurs among 1 in 4 LACC patients, which is notably less than clinical trials. These findings present an opportunity to broaden adoption of evidence-based radiation strategies, supporting optimal treatment delivery and improved patient outcomes. IMRT or VMAT non IMRT or VMAT Brachytherapy Non-brachytherapy Patient, N 73 177 189 61 Age (yrs, median) 51 54 51 59 Race (White), N(%) 50 (69) 101 (57) 114 (60) 37 (60) Race (non-White), N(%) 9 (12) 36 (20) 35 (19) 10 (16) Race (not documented), N(%) 14 (19) 40 (23) 40 (21) 14 (23) Stage I-II, N(%) 31 (42) 82 (46) 94 (50) 19 (31) Stage III, N(%) 23 (32) 65 (37) 64 (34) 24 (39) Stage IVA, N(%) 6 (8) 10 (6) 11 (6) 5 (8) Progression, N(%) 24 (33) 46 (26) 55 (29) 15 (25)