Major 30-day complications after radical radiotherapy: a population-based analysis and comparison with surgery

Radiotherapy (RT) is used commonly to treat localized prostate cancer, particularly among older men and men with comorbid illnesses. Few population-based studies have reported on the rates of major short-term complications that lead to hospitalization after radiotherapy.

In this study, the authors identified all men with nonmetastatic prostate cancer who received RT between 1990 and 1999 in Ontario, Canada. Patients who underwent a prior prostate-directed surgery were excluded. Mortality and complications after RT were examined by using administrative data. A comprehensive list of 7 categories of complications was developed by combining published lists from radical prostatectomy series with input from experts. Logistic regression was used to analyze the relations between complications (that occurred within 30 days of RT) and clinical factors. A similar analysis was performed among men who underwent radical prostatectomy during the same period.

There were 7661 men (mean age, 69 years) identified who received RT. Nine patients (0.1%) died within 30 days of RT. Any complication within 30 days of RT was experienced by 6.5% of patients. In analyses that were adjusted for year of treatment, increasing age was associated with any, respiratory, bleeding, genitourinary, and miscellaneous medical complications (P<.02) but not with cardiac, vascular, or bowel complications. Over time, any, cardiac, vascular, and genitourinary complications decreased, but the other 4 categories of complications did not decrease. Despite being older and having more comorbidity, men who received RT had lower complication rates in each category compared with 11,010 men who underwent radical prostatectomy.

Short-term complications that required hospital-based management were relatively uncommon after RT, commonly increased with patient age, and generally declined over time.