Abstract
We aimed to clarify the differences between the estimated rectal dose (ERD) and the first measured dose (FMD) and second measured dose (SMD) to the rectum during high-dose-rate (HDR) brachytherapy, and to predict FMD from the prostate volume (PV) or the rectal dose–volume parameters (RDVPs). ERD, FMD, and SMD were assessed with a rectal dosimeter during HDR brachytherapy of 18 Gy given in two fractions to 110 patients (48 hormone recipients, 62 hormone-naïve patients) with prostate cancer. The correlations between FMD and PV, and between FMD and RDVP (D 2ml–D 5ml) were investigated. ERD (mean ± SD) was 219 ± 44 cGy, FMD was 255 ± 52 cGy, and SMD was 298 ± 63 cGy, which differed significantly (p < 0.001). The correlation coefficients between ERD and FMD, and between FMD and SMD, were 0.82 and 0.78, respectively. SMD was equivalent to 118 ± 16 % FMD. The measured doses were significantly greater in the hormone recipients than in the hormone-naïve patients (p < 0.001). The increase in FMD correlated with the increases in PV and in RDVPs. The correlation coefficients between PV and FMD in all of the patients, in the hormone recipients, and in the hormone-naïve patients were 0.61, 0.64, and 0.64, respectively, whereas that between RDVPs and FMD was <0.53. In conclusion, the dose to the rectum increased with time and was correlated with the increases in PV and RDVPs. The correlation coefficient between FMD and PV was greater than that between FMD and RDVPs.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12194-014-0281-2/MediaObjects/12194_2014_281_Fig1_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12194-014-0281-2/MediaObjects/12194_2014_281_Fig2_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12194-014-0281-2/MediaObjects/12194_2014_281_Fig3_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12194-014-0281-2/MediaObjects/12194_2014_281_Fig4_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12194-014-0281-2/MediaObjects/12194_2014_281_Fig5_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12194-014-0281-2/MediaObjects/12194_2014_281_Fig6_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12194-014-0281-2/MediaObjects/12194_2014_281_Fig7_HTML.gif)
Similar content being viewed by others
References
Stromberg J, Martinez A, Gonzalez J, Edmundson G, Ohanian N, Vicini F, Hollander J, Gustafson G, Spencer W, Yan D, Brabbins D. Ultrasound-guided high dose rate conformal brachytherapy boost in prostate cancer: treatment description and preliminary results of a phase I/II clinical trial. Int J Radiat Oncol Biol Phys. 1995;33:161–71.
Martinez AA, Gustafson G, Gonzalez J, Armour E, Mitchell C, Edmundson G, Spencer W, Stromberg J, Huang R, Vinci F. Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer. Int J Radiat Oncol Biol Phys. 2002;53:316–27.
Demanes JD, Martinez AA, Ghilezan M, Hill DR, Schour L, Brandt D, Gustafson G. High-dose-rate monotherapy: safe and effective brachytherapy for patients with localized prostate cancer. Int J Radiat Oncol Biol Phys. 2011;81:1286–92.
Rogers CL, Alder CS, Rogers LR, Hopkins SA, Platt ML, Childs LC, Crouch RH, Hansen RS, Hayes JK. High dose brachytherapy as monotherapy for intermediate risk prostate cancer. J Urol. 2012;187:109–16.
Morton G, Loblaw A, Cheung P, Szumacher E, Chahal M, Danjoux C, Chung HT, Deabreu A, Mamedov A, Zhang L, Viqneault E, Springer C. Is single fraction 15 Gy the preferred high dose-rate brachytherapy boost dose for prostate cancer? Radiother Oncol. 2011;100:463–7.
Yoshioka Y, Nose T, Yoshida K, Inoue T, Yamazaki H, Tanaka E, Shiomi H, Imai A, Nakamura S, Shimamoto S, Inoue T. High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of a phase I/II clinical trial. Int J Radiat Oncol Biol Phys. 2000;48:675–81.
Hiratsuka J, Jo Y, Yoshida K, Nagase N, Fujisawa M, Imajo Y. Clinical results of combined treatment conformal high-dose-rate iridium-192 brachytherapy and external beam radiotherapy using staging lymphadenectomy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2004;59:684–90.
Akimoto T, Katoh H, Kitamoto Y, Tamaki T, Harada K, Shirai K, Nakano T. Rectal bleeding after high-dose-rate brachytherapy combined with hypofractionated external-beam radiotherapy for localized prostate cancer: impact of rectal dose in high-dose-rate brachytherapy on occurrence of grade 2 or worse rectal bleeding. Int J Radiat Oncol Biol Phys. 2006;65:364–70.
Sato M, Mori T, Shirai S, Kishi K, Inagaki T, Hara I. High-dose-rate brachytherapy of a single implant with two fractions combined with external beam radiotherapy for hormone-naive prostate cancer. Int J Radiat Oncol Biol Phys. 2008;72:1002–9.
Prada JP, Mendez L, Fernandez J, González H, Jiménez I, Arrojo E. Long-term biochemical results after high-dose-rate intensity modulated brachytherapy with external beam radiotherapy for high risk prostate cancer. Radiat Oncol. 2012;7:31.
Morton CG, Loblaw AD, Chung H, Tsang G, Sankreacha R, Deabreu A, Zhang L, Mamedov A, Cheung P, Batchelar D, Danjoux C, Szumacher E. Health-related quality of life after single-fraction high-dose-rate brachytherapy and hypofractionated external beam radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2011;80:1299–305.
Wattson AD, Chen MH, Moul WJ, Moran BJ, Dosoretz DE, Robertson CN, Polascik TJ, Braccioforte MN, Salenius SA, D’Amico AV. The number of high-risk factors and the risk of prostate cancer-specific mortality after brachytherapy: implications for treatment selection. Int J Radiat Oncol Biol Phys. 2012;82:e773–9.
Phan J, Swanson AD, Levy BL, Kudchadker RJ, Bruno TL, Frank SJ. Late rectal complications after prostate brachytherapy for localized prostate cancer. Cancer. 2009;115:1827–39.
Hsu IC, Bae K, Shinohara K, Pouliot J, Purdy J, Ibbott G, Speight J, Vigneault E, Ivker R, Sandler H. Phase II trial of combined high-dose-rate brachytherapy and external beam radiotherapy for adenocarcinoma of the prostate: preliminary results of RTOG 0321. Int J Radiat Oncol Biol Phys. 2010;78:751–8.
Egawa S, Shimura S, Irie A, Kitano M, Nishiguchi I, Kuwao S, Hasegawa K, Baba S. Toxicity and health-related quality of life during and after high dose rate brachytherapy followed by external beam radiotherapy for prostate cancer. Jpn J Clin Oncol. 2001;31:541–7.
Okamoto M, Ishikawa H, Ebara T, Kato H, Tamaki T, Akimoto T, Ito K, Miyakubo M, Yamamoto T, Suzuki K, Takahashi T, Nakano T. Rectal bleeding after high-dose-rate brachytherapy combined with hypofractionated external-beam radiotherapy for localized prostate cancer: the relationship between dose-volume histogram parameters and the occurrence rate. Int J Radiat Oncol Biol Phys. 2012;82:e211–7.
Araki F, Kouno T, Ohno T, Kakei K, Yoshiyama F, Kawamura S. Measurement of absorbed dose-to-water for an HDR192Ir source with ionization chambers in a sandwich setup. Med. Phys. 2013;40:092101-1–8.
Noda Y, Sato M, Shintaro S, Kishi K, Inagaki T, Mori T, Hara I. Efficacy and safety of high-dose-rate brachytherapy of single implant with two fractions combined with external beam radiotherapy for hormone-naïve localized prostate cancer. Cancers. 2011;3:3585–600.
Ishikawa H, Sato M, Shintaro S, Kishi K, Naya Y, Tokunaga H. Interfractional fluctuation of rectal dose in high dose rate brachytherapy for prostate cancer. Radiat Med. 2006;24:610–6.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Shimizu, N., Noda, Y., Sato, M. et al. Radiation dose to rectum in high-dose-rate brachytherapy with a single implant and two fractions for prostate cancer, and its prediction by prostate volume. Radiol Phys Technol 8, 18–25 (2015). https://doi.org/10.1007/s12194-014-0281-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12194-014-0281-2