Abstract
PURPOSE: Brachytherapy (BT) is recommended for vaginal cancer treatment, particularly cases of bulky and/or recurrent disease. However, previous studies noted a decline in utilization rates. This study examines recent trends in BT utilization to assess for reversal in trends. MATERIAL AND METHODS: This study analyzed the National Cancer Database (NCDB) of patients with FIGO stage I to IVA vaginal cancer treated between 2004 and 2021. A log binomial regression with robust variance was used to estimate incidence rate ratios (IRRs) of BT utilization over time and identify potential factors associated with receipt. RESULTS: Brachytherapy use increased from 48.0 % in 2004 to 63.3 % in 2021. Factors associated with increased brachytherapy use included, receiving care at an academic/research program (IRR: 1.35 95 % CI: 1.18-1.55), integrated cancer program (1.22 [1.06-1.41]), and diagnosis after 2018 (1.31 [1.21-1.42]). Factors associated with decreased use included American Indian or Alaskan Native race (0.55 [0.31-0.97]) when compared to white race, age over 70 (≥ 70-79 years: 0.91 [0.83-0.99]; ≥ 80 years: 0.68 [0.61-0.76]) when compared to age less than 50, and stage II (0.91 [0.86-0.96]), III (0.71 [0.67-0.75]), or IVA (0.43 [0.37-0.50]) disease when compared to stage I. Finally, geographic differences were also observed in BT use. CONCLUSIONS: In patients with stage I - IVA vaginal cancer from 2004 to 2021, brachytherapy utilization has significantly increased. These results indicate a recent start of the reversal of previously identified declining use of brachytherapy. However, more work is needed to ensure equitable use across demographic strata.