Comparing the rates of urinary tract infections among patients receiving adjuvant pelvic intensity modulated radiation therapy, 3-dimensional conformal radiation therapy, and brachytherapy for newly diagnosed endometrial cancer

Dustin Boothe; Suchit H Patel; Alex Stessin; Bhupesh Parashar; Dattatreyudu Nori; A Gabriella Wernicke

doi:10.1016/j.prro.2012.12.002

Comparing the rates of urinary tract infections among patients receiving adjuvant pelvic intensity modulated radiation therapy, 3-dimensional conformal radiation therapy, and brachytherapy for newly diagnosed endometrial cancer

Pract Radiat Oncol. 2013 Oct-Dec;3(4):269-74. doi: 10.1016/j.prro.2012.12.002. Epub 2013 Jan 28.

Authors

Dustin Boothe¹, Suchit H Patel¹, Alex Stessin¹, Bhupesh Parashar¹, Dattatreyudu Nori¹, A Gabriella Wernicke²

Affiliations

¹ Stich Radiation Center, Department of Radiation Oncology, Weill Cornell Medical College of Cornell University, New York, New York.
² Stich Radiation Center, Department of Radiation Oncology, Weill Cornell Medical College of Cornell University, New York, New York. Electronic address: gaw9008@med.cornell.edu.

PMID: 24674397
DOI: 10.1016/j.prro.2012.12.002

Abstract

Purpose: The purpose of this study was to compare the rates of urinary tract infection (UTI) among patients with endometrial cancer receiving vaginal brachytherapy alone and brachytherapy plus 3-dimensional conformal radiation therapy (3DCRT) or intensity modulated radiation therapy (IMRT).

Methods and materials: We retrospectively evaluated the rates of UTI among 581 patients diagnosed with endometrial cancer, treated between 2004 and 2012. A total of 37% (216/581) received brachytherapy alone, 28% (161/581) received brachytherapy plus 3DCRT, and 35% (204/581) received brachytherapy plus IMRT. UTI during the treatment was defined as evidence of pyuria detected by either urine dipstick or urinalysis. All specimens were collected as a clean catch, midstream void to avoid contamination and resultant false positives. The χ(2) and logistic regression analyses were subsequently employed for statistical analyses.

Results: UTI was diagnosed in 14.6% (85/581) of all patients. Only 2.8% (6/216) of patients receiving brachytherapy were diagnosed with a UTI during treatment, whereas UTI was diagnosed in 37.3% (60/161) of patients receiving brachytherapy plus 3DCRT, and 9.3% (19/204) of patients receiving brachytherapy plus IMRT (P < .0005). Logistic regression analysis found a decreased association between UTI and stage III endometrial cancer (odds ratio [OR], 0.51, 95% confidence interval [CI], 0.26, 0.99; P = .048). When compared with brachytherapy, both types of external beam radiation therapy were associated with an increased risk of UTI, though adjuvant 3DCRT (OR, 47.52, 95% CI, 14.81, 152.47; P < .001) had a more dramatic risk increase than IMRT (7.89, 95% CI, 2.26, 27.62; P = .001).

Conclusions: When compared with IMRT, 3DCRT is associated with a significantly increased risk of UTI, supporting the use of IMRT as the less toxic external beam radiation therapy for endometrial cancer.