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Stereotactic Body Radiation Therapy, Intensity-Modulated Radiation Therapy, and Brachytherapy Boost Modalities in Invasive Cervical Cancer: A Study of the National Cancer Data Base
  1. Barrett O'Donnell, BS*,
  2. Jay C. Shiao, BS,
  3. Todd A. Pezzi, BS, MBA,
  4. Nabila Waheed, DO,
  5. Shelly Sharma, MD,
  6. Mark D. Bonnen, MD and
  7. Michelle S. Ludwig, MD, MPH, PhD
  1. * McGovern School of Medicine at University of Texas Health Science Center Houston; and
  2. Baylor College of Medicine, Houston, TX.
  1. Address correspondence and reprint requests to Michelle Ludwig, MD, MPH, PhD, Department of Radiation Oncology, One Baylor Plaza, MS: BCM 360, Houston, Texas 77030-3411. E-mail: Michelle.Ludwig{at}


Background and Purpose Our objective was to determine whether stereotactic body radiotherapy (SBRT), intensity-modulated radiation therapy (IMRT), and brachytherapy boost techniques have comparable overall survival in treating cervical cancer when adjusted for known prognostic factors.

Materials and Methods We used the National Cancer Database to study women with invasive cervical cancer who were treated with radiation between 2004 and 2013. A logistic regression model was built to identify factors associated with the receipt of SBRT and IMRT. Outcomes were compared using Kaplan-Meier and propensity score matching.

Results Of all 15,905 patients, 14,394 (90.5%) received brachytherapy, 42 (0.8%) received SBRT, and 1468 (9.2%) received IMRT. After propensity score matching, there was no significant difference in overall survival (OS) for patients who received SBRT boost versus brachytherapy boost (hazard ratio = 1.477, 95% confidence interval = 0.746–2.926, P = 0.263) but a significant OS detriment in patients who received IMRT boost versus brachytherapy boost (hazard ratio = 1.455, 95% confidence interval = 1.300–1.628, P < 0.001).

Conclusions In a propensity-matched analysis, those who received SBRT boost had equal OS when compared with brachytherapy, but those who received IMRT boost had worse OS when compared with brachytherapy.

  • SBRT
  • Brachytherapy
  • Cervical cancer
  • Image-guided radiation therapy
  • Boost
  • IMRT
  • Survival
  • Biological effective dose

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  • The authors declare no conflicts of interest.