Trends in brachytherapy in utilization for vaginal cancer in the United States from 2004 to 2021

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. 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. 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. 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. •Brachytherapy utilization for vaginal cancer has significantly increased in the period between 2004 and 2021.•Several disparities exist in the use of brachytherapy across racial, geographic, and treatment-related strata.•Brachytherapy receipt is associated with improved survival in vaginal cancer patients.•More effort to ensure equitable access and distribution of the procedure is necessary.