The Lynx Group

External Beam Radiation More Toxic, Costlier than Brachytherapy or Prostatectomy

March 2012, Vol 3, No 2

San Francisco, CA—In a retrospective long-term comparative analysis of 3 prostate cancer treatment strategies, treatment with external beam radiation therapy (EBRT) was more toxic and costlier than prostatectomy and brachytherapy, according to Cleveland Clinic researchers who presented their data at the 2012 annual Genitourinary Cancers Symposium. In most other studies, the reported treatment-related toxicity data cover a follow-up period of only 5 years, said lead investigator Jay P. Ciezki, MD, Staff Physician, Cleveland Clinic. By contrast, the Cleveland Clinic study involved a median Everolimus Has Minimal follow-up of 71 months, and some patients were followed up for as long as 16 years. The researchers combed the SEERMedicare database collected between 1991 and 2007 for patients with prostate cancer treated with EBRT, prostatectomy, or brachytherapy.

"Using this database linkage that exists, we were able to associate billing codes with diagnoses. For example, we could associate billing codes not only with the treatment related toxicity that patients experienced after therapy but also the billing code associated with the initial therapy cost," said Dr Ciezki. "Using that information, we could compute a cost per patient-year with each treatment modality over time." The stage of prostate cancer in individual patients was not available in the SEER database. The database uncovered 137,427 patients aged ≥65 years at the time of their prostate cancer diagnosis. Among this group, 43% received prostatectomy, 44.2% EBRT, and 12.4% brachy therapy. None of the patients received combined therapy. Overall, 7.3% of patients required an intervention for a therapy-related adverse event. The cost per patient year for the 3 procedures was:

  •  $2557.36 for brachytherapy
  •  $3205.71 for prostatectomy
  •  $6412.29 for EBRT.

In addition, treatment-related toxicities were most frequent with EBRT. Genitourinary (GU) toxicity occurred in:

  •  3.4% who received brachytherapy
  •  6.7% who received prostatectomy
  •  7.1% of patients receiving EBRT.

The most frequent GU toxicity was urethral stricture (3.6% of all patients). At 15 years, the rate of GU toxicity was 5% to 6% with prostatectomy and 12% to 13% with EBRT. Cauterization of rectal bleeding was the most common gastrointestinal (GI) adverse effect (0.8% of all patients). "Well over 50% of the patients who had any GI toxicity expressed that with GI bleeding, usually rectal bleeding," said Dr Ciezki. GI adverse effects were also most frequent with EBRT (1.7%) compared with prostatectomy (0.1%) and brachy-therapy (0.3%).

"This is a fascinating piece of work," commented Nicholas J. Vogelzang, MD, Chair and Medical Director, Developmental Therapeutics Committee, US Oncology. "It begs the question as to why brachy therapy, which won the trifecta [least toxic in 2 areas, and most effective], if you will, is less used, at 12%. The lower cost is impressive, and I'm surprised that we don't see more use of that modality." Dr Ciezki said that at the inception of brachytherapy in the 1990s, "the target population that was promoted as being appropriate for this was the low-risk group, and people with small prostates. This limited the population to whom you would be applying brachytherapy. With more experience, people have gotten to the point where they're more comfortable offering it to more people."— WK

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