Abstract
Background: We compared treatment-related charges associated with external beam irradiation and interstitial implantation for soft-tissue sarcoma of the extremity.
Methods: Charges related to radiotherapy in 35 patients with soft-tissue sarcoma of the extremity were reviewed. Preoperative external beam irradiation (EB) delivering 50 Gy in 25 fractions with 6 MV photons was administered to 12 of the patients evaluated. The remaining 23 patients were treated with interstitial implantation (IR) as the only radiotherapeutic intervention. The anatomic distribution of the sarcomas treated by IR included 14 lower-extremity (LE) and nine upper-extremity (UE) lesions. The average length of iridium wire used for IR was 78 cm. Because LE lesions tend to be larger, the average length equaled 109.5 cm as compared with the 47 cm for UE implants.
Results: The radiotherapeutic approach represented the only difference in treatment-related charges because the operative procedure of wide local excision was performed in each group. No difference in perioperative complications was observed between the two treatment approaches. Charges were stratified according to hospital-based and professional services. Radiotherapy-based hospital charges for the administration of EB averaged $6,515 compared with $4,050 for IR (p<0.0001). Professional services also were significantly different, totaling $4,390 for EB and $3,240 for IR (p<0.0001). The total of these charges for radiotherapy procedures and professional fees equaled $10,905 for EB compared with $7,290 for IR (p<0.0001). Incorporating the necessary operating-room time for implant placement ($750) and five additional hospital days ($1,800), the costs associated with IR totaled $9,840; using chisquare analysis, the cost for IR remained significantly (p<0.0001) less expensive than the $10,905 associated with EB. Because a large component of the radiotherapy cost for IR is related to the length of iridium 192 wire required, charges were stratified according to the location of the tumor. The total charge for IR of the UE equaled $9,345 compared with $10,335 for LE implants. Chi-square comparison for both UE and LE implants continued to show significant differences (p<0.0001) when related to EB therapy.
Conclusion: Cost-analysis comparison of brachytherapy versus external beam irradiation found lower charges for patients undergoing adjuvant irradiation with brachytherapy for soft-tissue sarcoma. To optimize the cost-benefit ratio, prospective studies are necessary to define the application of these radiotherapeutic approaches based on clinical criteria.
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References
Robinson M, Barr L, Fisher C, et al. Treatment of extremity soft tissue sarcomas with surgery and radiotherapy.Radiother Oncol 1990;18:221–33.
Abbatucci JS, Boulier N, de Ranieri J, Mandard AM, Tanguy A, Busson A. Radiotherapy as an integrated part of the treatment of soft tissue sarcomas.Radiother Oncol 1984;2:115–21.
Barkley Jr. H, Martin RG, Romsdahl MM, Lindberg R, Zagars GK. Treatment of soft tissue sarcomas by preoperative irradiation and conservative surgical resection.Int J Radiat Oncol Biol Phys 1988;14:693–9.
Lindberg RD, Martin RG, Romsdahl MM, Barkley Jr. HT. Conservative surgery and postoperative radiotherapy in 300 adults with soft tissue sarcomas.Cancer 1981;47:2391–7.
Leibel SA, Tranbaugh RF, Wara WM, Beckstead JH, Bovill EG, Phillips TL. Soft tissue sarcomas of the extremities: survival and patterns of failure with conservative surgery and postoperative irradiation compared to surgery alone.Cancer 1982;50:1076–83.
Suit HD, Mankin HJ, Wood WC, et al. Treatment of the patient with Stage Mo soft tissue sarcoma.J Clin Oncol 1988;6:854–62.
Simon MA, Enneking WF. The management of soft tissue sarcoma of the extremities.J Bone Joint Surg 1976;58A:317–27.
Krarup-Hansen A, Poulsen HS. Extra-visceral soft tissue sarcomas in adults: local treatment with special reference to irradiation.Cancer Treat Rev 1989;16:221–46.
Karakousis CP, Emrich LJ, Rao U, Krishnamsetty RM. Feasibility of limb salvage and survival in soft tissue sarcomas.Cancer 1986;57:484–91.
Pao WJ, Pilepich MV. Postoperative radiotherapy in the treatment of extremity soft tissue sarcomas.Int J Radiat Oncol Biol Phys 1990;19:907–11.
Suit HD, Mankin HJ, Wood WC, Proppe KH. Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma.Cancer 1985;55:2659–67.
Suit HD, Proppe KH, Mankin HJ, Wood WC. Preoperative radiation therapy for sarcoma of soft tissue.Cancer 1981;47:2269–74.
Brennan MF, Hilaris B, Shiu MH, et al. Local recurrence in adult soft-tissue sarcoma: a randomized trial of brachytherapy.Arch Surg 1987;122:1289–93.
Brennan MF, Casper ES, Harrison LB, Shiu MH, Gaynor J, Hajdu SI. The role of multimodality therapy in soft-tissue sarcoma.Ann Surg 1991;214(3):328–38.
Zelefsky MJ, Harrison LB, Shiu MH, Armstrong JG, Hajdu SI, Brennan MF. Combined surgical resection and iridium 192 implantation for locally advanced and recurrent desmoid tumors.Cancer 1991;67:380–4.
Shiu MH, Collin C, Hilaris BS, et al. Limb preservation and tumor control in the treatment of popliteal and antecubital soft tissue sarcomas.Cancer 1986;57:1632–9.
Arbeit JM, Hilaris BS, Brennan MF. Wound complications in the multimodality treatment of extremity and superficial truncal sarcomas.J Clin Oncol 1987;5:480–8.
Paine CH, Ash DV. Interstitial brachytherapy: past-present-future.Int J Radiat Oncol Biol Phys 1991;21:1479–83.
Enneking WF, Maale GE. The effect of inadvertent tumor contamination of wounds during the surgical resection of musculoskeletal neoplasms.Cancer 1988;62:1251–6.
Udvarhelyi IS, Colditz GA, Rai A, Epstein AM. Cost-effective and cost-benefit analyses in the medical literature.Ann Intern Med 1992;116:238–44.
Fahs MC, Mandelblatt J, Schechter C, Muller C. Cost effectiveness of cervical cancer screening for the elderly.Ann Int Med 1992;117:520–7.
Harris RP, Fletcher SW, Gonzalez JJ, Lannin DR, Degnan D, Earp JA, Clark R. Mammography and age: are we targeting the wrong women?Cancer 1991;67:2010–14.
Fraser NM, Clarke PR. Cost-effectiveness of breast cancer screening.Breast 1992;1:169–72.
Clark RA. Economic issues in screening mammography.AJR 1992;158:527–34.
Hanks GE. The crisis in health care cost in the United States: some implications for radiation oncology.Int J Radiat Oncol Biol Phys 1992;23:203–6.
Frierson RL. Suicide attempts by the old and the very old.Arch Intern Med 1991;151:141–4.
Kane RA. Psychosocial issues: psychological and social issues for older people with cancer.Cancer 1991;68(suppl 1)1:2514–8.
Harris JE. The treatment of cancer in an aging population.JAMA 1992;268:96–7.
Yancik R, Ries LG. Cancer in the aged: an epidemiologic perspective on treatment issues.Cancer 1991;68(suppl 1):2502–10.
Maher EJ, Coia L, Duncan G, Lawton PA. Treatment strategies in advanced and metastatic cancer: differences in attitude between the USA, Canada, and Europe.Int J Radiat Oncol Biol Phys 1992;23:239–44.
Bergman L, Dekker G, van Kerkhoff EHM, Peterse HL, van Dongen JA, van Leeuwen FE. Influence of age and comorbidity on treatment choice and survival in elderly patients with breast cancer.Breast Cancer Treat 1991;18:189–98.
Hanks GE, Maher EJ, Coia L. An overview of the First International Consensus Workshop on radiation therapy in the treatment of metastatic and locally advanced cancer.Int J Radiat Oncol Biol Phys 1992;23:201.
Balducci L, Ades T, Carbone PP, Friedman M, Fulmer T, Galakotos A, Yancik R. Issues in treatment.Cancer 1991;68(suppl 1):2527–9.
Janjan NA, Nattinger AB, Young M, Wilson JF. First year treatment charges for early stage vs. advanced stage breast cancer.Breast Dis 1993;6:27–37.
Taylor JMG, Mendenhall WM, Lavey RS. Dose, time, and fraction size issues for late effects in head and neck cancers.Int J Radiat Oncol Biol Phys 1991;22:3–11.
Courdi A, Hery M, Gabillat JM. Alternate day treatment and late effects: the concept of an effective dose per fraction.Int J Radiat Oncol Biol Phys 1990;19:1225–8.
Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation.Int J Radiat Oncol Biol Phys 1991;21:109–22.
Douglas BG, Fowler JF. The effect of multiple small doses of x-rays on skin reactions in the mouse and a basic interpretation.Radiat Res 1976;66:401–26.
Turesson I, Notter G. The predictive value of skin telangiectasia for late radiation effects in different normal tissues.Int J Radiat Oncol Biol Phys 1986;12:603–9.
Turesson I, Notter G. The response of pig skin to single and fractionated high dose-rate and continuous low dose rate137cesium irradiation-I: experimental design and results.Int J Radiat Oncol Biol Phys 1979;21:835–44.
Von Essen CF. A spatial model of time-dose-area relationships in radiation therapy.Radiology 1963;81:881–3.
Von Essen CF. Clinical radiation tolerance of skin and upper aerodigestive tract.Front Radiat Ther Oncol 1972;6:148–59.
Brant TA, Parsons JT, Marcus RB, et al. Preoperative irradiation for soft tissue sarcomas of the trunk and extremities in adults.Int J Radiat Oncol Biol Phys 1990;19:899–906.
Karasek K, Constine LS, Rosier R. Sarcoma therapy: functional outcome and relationship to treatment parameters.Int J Radiat Oncol Biol Phys 1992;24:651–6.
Donohue JH, Collin C, Friedrich C, Godbold J, Hajdu SI, Brennan MF. Low-grade soft tissue sarcomas of the extremities: analysis of risk factors for metastasis.Cancer 1988;62:184–93.
Stotter AT, A'Hern RP, Fisher C, Mott AF, Fallowfield ME, Westbury G. The influence of local recurrence of extremity soft tissue sarcoma on metastasis and survival.Cancer 1990;65:1119–29.
Abbas JS, Holyoke ED, Moore R, et al. The surgical treatment and outcome of soft tissue sarcoma.Arch Surg 1981;116:765–9.
Shiu MH, Castro EB, Hajdu SI, Fortner JG. Surgical treatment of 297 soft tissue sarcomas of the lower extremity.Ann Surg 1975;182:597–602.
Eilber FR, Guiliano AE, Huth J, Mira J, Morton DL. High-grade soft tissue sarcomas of the extremity: UCLA experience with limb salvage.Prog Clin Biol Res 1985;201:59–74.
Potter DA, Glenn J, Kinsella T, et al. Patterns of recurrence in patients with high grade soft tissue sarcomas.J Clin Oncol 1985;3:353–66.
Guiliano AE, Eilber FR, Morton DL. The management of locally recurrent soft-tissue sarcoma.Ann Surg 1982;196:87–91.
Cantin J, McNeer GP, Chu FC, Booher RJ. The problem of local recurrence after treatment of soft tissue sarcoma.Ann Surg 1968;168:47–53.
Markhede G, Augervall L, Stener B. A multivariate analysis of the prognosis after surgical treatment of soft tissue tumors.Cancer 1982;49:1721–33.
Pezzi CM, Rawlings MS, Esgro JJ, Pollock RE, Romsdahl MM. Prognostic factors in 227 patients with malignant fibrous histiocytoma.Cancer 1992;69:2098–103.
Sears HF, Hopson R, Inouye W, Rizzo T, Grotzinger PJ. Analysis of staging and management of patients with sarcoma.Ann Surg 1980;191(4):488–93.
Costa J, Wesley RA, Glatstein E, Rosenberg SA. The grading of soft tissue sarcomas: results of a clinicohistopathologic correlation in a series of 163 cases.Cancer 1984;53:530–41.
Rooser B, Attewell R, Berg NO, Rydholm A. Prognostication in soft tissue sarcoma: a model with four risk factors.Cancer 1988;61:817–23.
Rydholm A, Gustafson P, Rooser B, Willen H, Akerman M, Herrlin K, Alvegard T. Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma.J Clin Oncol 1991;9:1757–65.
Berlin O, Stener B, Angervall L, et al. Surgery for soft tissue sarcoma in the extremities: a multivariate analysis of the 6–26 year prognosis in 137 patients.Acta Orthop Scand 1990;61:475–86.
Collin C, Godbold J, Hajdu S, Brennan M. Localized extremity soft tissue sarcoma: an analysis of factors affecting survival.J Clin Oncol 1987;5:601–12.
Shieber W, Graham P. An experience with sarcomas of the soft tissues in adults.Surgery 1962;52:295–8.
Mandard AM, Petiot JF, Marnay J, et al. Prognostic factors in soft tissue sarcomas: multivariate analysis of 109 cases.Cancer 1989;63:1437–51.
Willett CG, Schiller AL, Suit HD, Mankin HJ, Rosenberg A. The histologic response of soft tissue sarcoma to radiation therapy.Cancer 1987;60:1500–4.
Fagundes HM, Lai PP, Dehner LP, et al. Postoperative radiotherapy for malignant fibrous histiocytoma.Int J Radiat Oncol Biol Phys 1992;23:615–19.
Perez CA, Kobeissi B, Smith BD, et al. Cost accounting in radiation oncology: a computer-based model for reimbursement.Int J Radiat Oncol Biol Phys 1993;25:895–906.
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Janjan, N.A., Yasko, A.W., Reece, G.P. et al. Comparison of charges related to radiotherapy for soft-tissue sarcomas treated by preoperative external-beam irradiation versus interstitial implantation. Annals of Surgical Oncology 1, 415–422 (1994). https://doi.org/10.1007/BF02303815
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DOI: https://doi.org/10.1007/BF02303815