Trends in cervical cancer brachytherapy volume suggest case volume is not the primary driver of poor compliance rates with brachytherapy delivery for locally advanced cervical cancer

Purpose The aim of this study was to evaluate temporal trends in the volume of cervical cancer brachytherapy cases available to trainees as a potential contributing factor to national trends toward decreased utilization of brachytherapy for locally advanced cervical cancer. Methods and Materials The National Cancer Database was queried to identify a cohort of women diagnosed with locally advanced cervical cancer during 2004–2013 who received primary radiation therapy. We identified academic facilities that reported radiation therapy and brachytherapy delivery the study period, categorized facilities based on annual number of cases, and evaluated temporal trends. Results A total of 6290 patients treated at 220 facilities were evaluated. During the study period, the proportion of facilities with higher brachytherapy volume remained stable. The trend of each grouping was not significant (p > 0.05) with the exception of centers treating one case per year, which demonstrated a decrease over time (p = 0.022). Conclusions Our analysis suggests that cervical cancer case volume at academic institutions, available for resident training, was stable throughout the study period. These findings suggest that targeting resident educational programs should not be the highest priority for interventions to improve rates of appropriate brachytherapy utilization for cervical cancer.