Worldwide, cervical cancer is the fourth most commonly diagnosed cancer and the fourth leading cause of cancer-related death, accounting for approximately 604,000 new cases with 342,000 deaths in 2020 [1,2]. In the United States, there are an estimated 13,960 new diagnoses of cervical cancer yearly [3].

Cervical cancer management may include surgery, external beam radiotherapy (EBRT), brachytherapy, systemic therapy, or a combination of these. For very early stage disease, definitive surgery is an option, although adjuvant therapy including radiation therapy may be indicated for adverse pathologic factors, such as large tumor size, lymphovascular space invasion, and deep stromal invasion. Therefore, as early as Stage IB1, EBRT with brachytherapy with or without systemic therapy can be considered, with combined EBRT with brachytherapy as the standard of care and a category 1 recommendation per the National Comprehensive Cancer Network (NCCN) starting in Stage IB3 [4]. The standard chemoradiotherapy treatment paradigm is a platinum-based systemic therapy given concurrently with pelvic EBRT, followed by tandem-based brachytherapy to provide additional radiation dose to the residual tumor [[5], [6], [7]].

The addition of brachytherapy to EBRT is critical for cervical cancer [8,9]. Prior research has shown that a brachytherapy boost has a survival advantage compared to an EBRT boost for all cervical cancer stages grouped and individually [10]. The most recent treatment recommendations published by the American Brachytherapy Society (ABS) reported several common brachytherapy dose and fractionation schedules, including 700 cGy × 4 fractions, 600 cGy × 5 fractions, 550 cGy × 5 fractions, and 500 cGy × 6 fractions [11]. However, there is limited data on the physician practice pattern of cervical cancer brachytherapy in the US, which restricts assessments of ABS guideline adherence and evaluations of brachytherapy-related disparity in patient care with any associated patient outcome. This study thus sought to provide the first national assessment of this brachytherapy practice pattern for cervical cancer, with a special emphasis on the brachytherapy dose and fractionation regimens.