COMPARISON OF CHARGES RELATED TO RADIOTHERAPY FOR SOFT-TISSUE SARCOMAS TREATED BY PREOPERATIVE EXTERNAL-BEAM IRRADIATION VERSUS INTERSTITIAL IMPLANTATION

Background: We compared treatment-related charges associated with exte rnal beam irradiation and interstitial implantation for soft-tissue sa rcoma of the extremity. Methods: Charges related to radiotherapy in 35 patients with soft-tissue sarcoma of the extremity were reviewed. Pre operative external beam irradiation (EB) delivering 50 Gy in 25 fracti ons with 6 MV photons was administered to 12 of the patients evaluated . The remaining 23 patients were treated with interstitial implantatio n (IR) as the only radiotherapeutic intervention. The anatomic distrib ution of the sarcomas treated by IR included 14 lower-extremity (LE) a nd nine upper-extremity (UE) lesions. The average length of iridium wi re used for IR was 78 cm. Because LE lesions tend to be larger, the av erage length equaled 109.5 cm as compared with the 47 cm for UE implan ts. Results: The radiotherapeutic approach represented the only differ ence in treatment-related charges because the operative procedure of w ide local excision was performed in each group. No difference in perio perative complications was observed between the two treatment approach es. Charges were stratified according to hospital-based and profession al services. Radiotherapy-based hospital charges for the administratio n of EB averaged $6,515 compared with $4,050 for IR (p < 0.0001). Prof essional services also were significantly different, totaling $4,390 f or EB and $3,240 for IR (p < 0.0001). The total of these charges for r adiotherapy procedures and professional fees equaled $10,905 for EB co mpared with $7,290 for IR (p < 0.0001). Incorporating the necessary op erating-room time for implant placement ($750) and five additional hos pital days ($1,800), the costs associated with IR totaled $9,840; usin g chi-square analysis, the cost for IR remained significantly (p < 0.0 001) less expensive than the $10,905 associated with EB. Because a lar ge 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 $9,3 45 compared with $10,335 for LE implants. Chi-square comparison for bo th UE and LE implants continued to show significant differences (p < 0 .0001) when related to EB therapy. Conclusion: Cost-analysis compariso n of brachytherapy versus external beam irradiation found lower charge s for patients undergoing adjuvant irradiation with brachytherapy for soft-tissue sarcoma. To optimize the cost-benefit ratio, prospective s tudies are necessary to define the application of these radiotherapeut ic approaches based on clinical criteria.