# Trends in radiotherapy use and implementation challenges among patients with cervical cancer: a multicenter study in Osaka, Japan

## TL;DR

This study examines how radiotherapy use for cervical cancer has changed in Osaka, Japan, from 2016 to 2023, finding an overall increase but with variation across hospitals.

## Contribution

The study provides new insights into trends and challenges in cervical cancer radiotherapy implementation in Japan following revised guidelines.

## Key findings

- Radiotherapy use increased for cervical cancer stages IB–IIA, IIB, and IIIC in Osaka from 2016 to 2023.
- The increase in radiotherapy varied across institutions, with only three out of 11 brachytherapy centers showing growth.
- Surgical treatment declined as radiotherapy became more common.

## Abstract

Since 2018, the staging system and guidelines for cervical cancer have been revised in Japan. Here, we analyzed trends in radiotherapy use among patients with cervical cancer in Osaka Prefecture, Japan. We obtained records from hospital-based cancer registries (2016–23) linked to Diagnosis Procedure Combination data (2019–23), from 67 nationally or prefecturally designated cancer care hospitals. Eligible patients had epithelial or neuroendocrine cervical cancer, excluding those with clinical stage 0 or unknown clinical stage with pathological stage 0. Between 2016 and 2023, the number of patients per year remained stable (717–787); the number of stage IB–IIA (FIGO 2018) cases decreased, whereas that of stages IIB or IIIC (T1–2) cases increased. The number of patients receiving radiotherapy as initial treatment increased from 229 in 2016 to 294 in 2023; this was accompanied by a decline in surgical treatment. The proportion of patients undergoing radiotherapy increased from 11.9% to 17.2% for stage IB–IIA, from 55.6% to 71.7% for stage IIB and from 38.0% to 69.5% for stage IIIC (T1–2). Among 11 institutions providing brachytherapy, the number of radiotherapy cases increased at three, whereas it remained stable or declined at the other eight. These findings indicate a growing trend in radiotherapy use for cervical cancer in Osaka Prefecture; however, the increase varied by institution. To sustain cervical cancer radiotherapy services, further studies may be needed to assess the adequacy of brachytherapy staffing, explore the financial feasibility of brachytherapy equipment, and examine the potential implications of brachytherapy centralization.