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

Abstract

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. 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. 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).Abstract SU_30_2291; TableSummary of ComplicationsComplicationsN%None47782.0LUTS498.4Bladder Injury234.0Urinary Retention223.8Urinary Stricture101.7Rectal30.5Cardiopulmonary111.9 Open table in a new tab 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.