Genitourinary Cancer

PV QA 1 - Poster Viewing Q&A 1

SU_29_2291 - Acute and Subacute Complications of Brachytherapy for Prostate Cancer: A Single Institution Claims-Based Analysis

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Acute and Subacute Complications of Brachytherapy for Prostate Cancer: A Single Institution Claims-Based Analysis
D. Lee1, E. Handorf1, T. M. Churilla1, M. Smaldone1, J. Hellstrom1, N. Waingankar2, D. Chen1, M. A. Hallman1, M. L. Sobczak1, B. K. Leachman1, and E. M. Horwitz1; 1Fox Chase Cancer Center, Philadelphia, PA, 2Mount Sinai, New York, NY

Purpose/Objective(s): While late toxicity associated with prostate brachytherapy is well-described, there are few data reporting short-term procedural complications. We sought to quantify the perioperative and postoperative complications of high dose rate (HDR) and low dose rate (LDR) brachytherapy among patients treated at a single institution. We hypothesized a low incidence of acute brachytherapy complications.

Materials/Methods: Patients age >18 who had biopsy proven adenocarcinoma of the prostate and underwent treatment with HDR or LDR between 1998-2014 were identified from a prospective institutional database. We identified ICD-9, ICD-10, and CPT billing codes associated with potential perioperative complications or events, divided into six categories [lower urinary tract symptoms (LUTS), bladder injury, urinary retention, urethral stricture, rectal, and cardiopulmonary complications]. Claims data were queried for these codes, and presence of one or more of these billing codes within 4 months of treatment was inferred as a complication associated with brachytherapy. We used Fisher’s exact tests and Wilcoxon tests to determine the association between the complication groups and patient/treatment factors. For continuous measures of interest, we used classification and regression trees to find optimal cut points

Results: There were 582 patients identified, including 97 treated with HDR using 192iridium (192Ir), and 485 treated with LDR using 125iodine (125I) or 103palladium (103Pd). Complications were identified in 105 (18%) of patients. Of those patients identified, 28 had 2 codes, 23 had 3-6 codes, and 1 had 15 codes (see table). On univariate analysis, a baseline diagnosis of heart disease was associated with cardiopulmonary complications (OR 4.97, 95% CI 1.48-16.67, p=0.03). Having an American Urologic Association (AUA) score of >7 was associated with LUTS (17% vs 6% complication rate, p = 0.0005). Prostate size was not associated with increased risk of urinary retention for either HDR (OR 1.05, 95% CI 0.97-1.12, p=0.13) or LDR (OR 1.04, 95% CI 1.00-1.09, p=0.06). Table: Summary of Complications
Complications N %
None 477 82.0
LUTS 49 8.4
Bladder Injury 23 4.0
Urinary Retention 22 3.8
Urinary Stricture 10 1.7
Rectal 3 0.5
Cardiopulmonary 11 1.9

Conclusion: Among well-selected patients, the overall incidence of procedural-related complications within 4 months of brachytherapy is less than 20%. Lower urinary tract symptoms represent the most common complication with an approximate 4% incidence of urinary retention. Serious cardiopulmonary events were very rare (< 2%) and associated with baseline cardiovascular risk factors. These data provide further evidence for the safety of brachytherapy among patients treated at a single institution with expertise in this treatment.

Author Disclosure: D. Lee: None. E. Handorf: None. T.M. Churilla: Travel Grant; ASTRO Travel Grant. Alumni Committee Chairperson; The Commonwealth Medical College. M. Smaldone: None. J. Hellstrom: None. N. Waingankar: None. D. Chen: None.

Douglas Lee, DO

Fox Chase Cancer Center

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