Association of Hospital Volume With Racial and Ethnic Disparities in Locally Advanced Cervical Cancer Treatment.

OBJECTIVE: To evaluate racial-ethnic disparities in guideline-based care in locally advanced cervical cancer and their relationship to hospital case volume. METHODS: Using the National Cancer Database, we performed a retrospective cohort study of women diagnosed between 2004 and 2012 with locally advanced squamous or adenocarcinoma of the cervix undergoing definitive primary radiation therapy. The primary outcome was the race-ethnicity-based rates of adherence to the National Comprehensive Cancer Network guideline-based care. The secondary outcome was the effect of guideline-based care on overall survival. Multivariable models and propensity matching were used to compare the hospital risk-adjusted rates of guideline-based adherence and overall survival based on hospital case volume. RESULTS: The final cohort consisted of 16,195 patients. The rate of guideline-based care was 58.4% (95% confidence interval [CI] 57.4-59.4%) for non-Hispanic white, 53% (95% CI 51.4-54.9%) for non-Hispanic black, and 51.5% (95% CI 49.4-53.7%) for Hispanic women (P<.001). From 2004 to 2012, the rate of guideline-based care increased from 49.5% (95% CI 47.1-51.9%) to 59.1% (95% CI 56.9-61.2%) (Ptrend<.001). Based on a propensity score-matched analysis, patients receiving guideline-based care had a lower risk of mortality (adjusted hazard ratio 0.65, 95% CI 0.62-0.68). Compared with low-volume hospitals, the increase in adherence to guideline-based care in high-volume hospitals was 48-63% for non-Hispanic white, 47-53% for non-Hispanic black, and 41-54% for Hispanic women. CONCLUSION: Racial and ethnic disparities in the delivery of guideline-based care are the highest in high-volume hospitals. Guideline-based care in locally advanced cervical cancer is associated with improved survival.

Image-guided percutaneous thermal ablation of metastatic pelvic tumor from gynecologic malignancies.

BACKGROUND: Image-guided percutaneous thermal ablation is a commonly performed therapeutic procedure for various tumors. Thermal ablation is not frequently used in the pelvis as a result of anatomic concerns and the potential risk of nontarget tissue injury. TECHNIQUE: Percutaneous thermal ablation is a minimally invasive procedure involving special probes inserted through the skin to the target lesion under imaging guidance. Various delivery methods of thermal ablation exist, including radiofrequency ablation, which burns tissue, and cryoablation, which freezes tissue with an ultimate goal to destroy the target tumor while minimizing damage to adjacent structures. Protective measures can be used to provide access and safe treatment delivery such as pyeloperfusion to protect the ureter with the infusion of water using a ureteral stent or hydrodissection to protect adjacent structures by displacing them away with the infusion of water using percutaneously placed needles. EXPERIENCE: The authors' experience with the technique involves thermal ablation of recurrent pelvic tumor in three patients with various gynecologic malignancies who each had a single focus of pelvic recurrence after surgical resection and radiation treatment. No residual or recurrent disease was seen at the treatment site on follow-up imaging consistent with local tumor control. CONCLUSION: Thermal ablation of metastatic or recurrent pelvic tumor is technically feasible and should be considered in selected patients with no treatment alternative.