Patterns of Care for Stage IA Cervical Cancer: Use of Definitive Radiation Therapy Versus Hysterectomy

Objective: The standard of care for clinical IA cervical cancer is surgery, but nonoperative cases may receive definitive radiation therapy (RT). Herein, we investigated national practice patterns associated with the administration of definitive RT as compared with hysterectomy-based surgery (HYS) as well as delivery of adjuvant RT after HYS. Methods/Materials The National Cancer Data Base (NCDB) was queried for clinical IA primary cervical cancer cases (2004-2013) receiving definitive RT or HYS with or without adjuvant RT. Patients with unknown RT or surgery status were excluded, as were benign histologies and receipt of non-HYS such as fertility-sparing surgery. Patient, tumor, and treatment parameters were extracted. Univariable and multivariable logistic regression determined variables associated with receipt of RT and HYS. Results: In total, 3816 patients were analyzed (n = 3514 [92.1%] HYS alone, n = 100 [2.6%] RT alone, n = 202 [5.3%] combination). On multivariable analysis of HYS versus definitive RT, RT was more likely to be given to patients who were older (P < 0.001) and with Medicare (P = 0.011), Medicaid/other government insurance (P = 0.011), or uninsured/unknown status (P = 0.003). In addition, treatment with surgery alone was associated with patients in the 2 highest income quartiles (P = 0.013, P = 0.054). On multivariable analysis of patients receiving RT in addition to HYS, adjuvant RT was added most commonly for positive margins (P < 0.001) and increasing age (P < 0.001). Conclusions: This is the largest analysis to date evaluating definitive RT for IA cervical cancer. Younger age and higher socioeconomic status are associated with receipt of HYS instead of definitive RT, and positive margins are most associated with the addition of adjuvant RT. Although these data must be further validated with better defined patient selection and do not imply causation, several socioeconomic findings discovered herein need to be addressed to ensure the highest quality cancer care to all patients.