EBRT more toxic, costly vs. surgery, brachytherapy for prostate cancer

2011 ASTRO Annual Meeting

MIAMI - A database analysis of the three major treatment modalities for prostate cancer showed that external beam radiotherapy was associated with the most adverse events and greatest costs, said Jay Ciezki, MD, a staff member of the department of radiation oncology at Cleveland Clinic Taussig Cancer Center.

Ciezki discussed the results of a poster presented at the 2011 ASTRO Annual Meeting. He told HemOnc Today that researchers reviewed the database for adverse events serious enough to require surgery, which appeared in the database as a billable event.

"With both GU and GI toxicity, patients who got external beam had many, many more of those billable events occur," he said. "Thankfully, there was not that much GI toxicity, but there was actually quite a lot of GU toxicity. That is something that requires further investigation."

Ciezki said researchers are now conducting a trial to determine why rates of genitourinary toxicity were so high in these patients.

Ciezki and colleagues examined the SEER-Medicare linked database for 16 years of follow-up data on treatment-toxicity associated with EBRT, prostatectomy and brachytherapy collected from 1991 to 2007. They then used current Medicare reimbursement rates for the initial treatment and any toxicity- related interventions and computed the cost per patient-year within each treatment modality over time.

A total of 137,427 patients who were 65 years or older at the time of diagnosis and who had prostate cancer as their only cancer diagnosis were included in the analysis. Most patients, 44.2%, were treated with EBRT; 44.3% were treated with prostatectomy and 12.4% underwent brachytherapy. No patient received combined therapy.

Median follow-up was 71 months.

EBRT represented the most expensive annual treatment per-patient at $6,412 compared with $3,205 for prostatectomy and $2,557 for brachytherapy.

Overall, 7.3% of patients experienced a treatment-related toxicity. Almost 9% of those treated with EBRT had an adverse event (8.8%) compared with 6.9% for surgery and 3.7% for brachytherapy. Dilation of a urethral stricture was the most common genitourinary toxicity (3.6%) while cauterization of rectal bleeding was the most common gastrointestinal toxicity (0.8%).

Ciezki cautioned that the database only collected data for grade-3/grade-4 side effects, so these results do not reflect the incidence or costs associated with minor toxicities. He added that the majority of treatment costs represented the cost of the initial therapy, rather than treating the toxicity.

"The database doesn't take into account more subtle adverse events, grade-1/grade-2 toxicities," he said. "We can't give a complete recommendation to physicians, but we can say that patients who undergo external beam therapy may well be at greater risk for surgical intervention in the future." - by Jason Harris

For more information:

Ciezki JP. #2372. Presented at: 2011 ASTRO Annual Meeting; Oct. 2-6, 2011; Miami.

Disclosure: Dr. Ciezki reported no relevant financial disclosures.

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