stages I and IIA, men typically well-suited
for BT alone. The stage IIB patients were
separately reviewed given the potential benefit
of using a combination of EBRT with a BB.
In the lower-risk group, slightly more
patients were treated with BT rather than
EBRT in 2004 ( 15. 1 percent versus 14. 2 percent).
By 2016, only 5. 1 percent were treated with
BT, one-third the 2004 levels. Patients treated
with EBRT, however, were 14. 2 percent
with no change during the years studied.
The stage IIB patients also experienced
a decline in the reliance on BT. Patients
getting EBRT with a BB decreased from
6. 3 percent to 3. 2 percent, whereas patients
treated with BT alone dropped from 5. 8
percent to 2. 1 percent. At the same time, use
of EBRT alone increased from 17. 5 percent
to 19. 3 percent (see Figure 1, page 66).
Several explanations have been offered
to rationalize this decline in the use of
brachytherapy, including decreasing expertise
and fewer training opportunities. For example,
Orio and colleagues found the percentage of
academic practices performing BT decreased
from 80 percent in 2004 to 65 percent in 2012,
while the percentage in nonacademic practices
declined from 75 percent to 55 percent
in the same time frame. 17 Academic and
nonacademic practices performing at least
53 cases per year were few and decreased to
1. 5 percent and 2. 7 percent, respectively.
The economic incentives also favor EBRT
over BT. Dutta and colleagues performed what
they described as a time-driven and activity-
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continued on next page
NCDB CANCER BYTES
The use of BT as monotherapy is supported by
the National Comprehensive Cancer Network
guidelines for patients with very low, low,
and favorable intermediate-risk disease.