Abstract
Purpose
To analyze rectal bleeding prognostic factors associated with prostate brachytherapy (PB) or in combination with external-beam radiation therapy (EBRT) and to examine dosimetric indications associated with rectal bleeding.
Materials and methods
The study included 296 patients followed up for >36 months (median, 48 months). PB was performed alone in 252 patients and in combination with EBRT in 44 patients. PB combined with EBRT is indicated for patients with a Gleason score >6. The prescribed dose was 144 Gy for monotherapy and 110 Gy for PB + EBRT (44–46 Gy).
Results
Although 9.1% who received monotherapy had 2.3% grade 2 rectal bleeding, 36.3% who received combined therapy had 15.9% grade 2 rectal bleeding. Combined therapy was associated with higher incidence of rectal bleeding (P = 0.0049) and higher percentage of grade 2 bleeding (P = 0.0005). Multivariate analysis revealed that R-150 was the only significant factor for rectal bleeding, and modified Radiation Therapy Oncology Group (RTOG) grade in monotherapy and biologically equivalent dose (BED) were significant for combined therapy. Moreover, grade 2 rectal bleeding increased significantly at D90 > 130 Gy.
Conclusion
Although R-150 was the significant prognostic factor for rectal bleeding and modified RTOG rectal toxicity grade, BED was the significant prognostic factor for modified RTOG rectal toxicity grade.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Stone N, Potters L, Davis B, Zelefsky M, Roach M, Fearn P, et al. Multicenter analysis of impact of high biologically effective dose (BED) on biochemical failure (Phoenix definition) and survival outcomes in patients with Gleason score 7–10 prostate cancer treated by permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2007;69:85–86.
Sylvester J, Grimm P, Blasko J, Millar J, Orio P, Skoglund S, et al. 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; the Seattle Experience. Int J Radiat Oncol Biol Phys 2007;67:57–64.
Potters L, Purrazzella R, Brustein S, Fearn P, Huang D, Leibel S, et al. The prognostic significance of Gleason grade in patients treated with permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2003;56:749–754.
Stock R, Stone N, Cesaretti J, Rosenstein B. Biologically effective dose values for prostate brachytherapy: effects on PSA failure and postimplant biopsy results. Int J Radiat Oncol Biol Phys 2006;64:527–533.
Cox J, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31:1341–1346.
Gelblum D, Potters L. Rectal complications associated with transperineal interstitial brachytherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2000;48:119–124.
Stock R, Cesarett J, Yeh J, Stone N. Long-term outcomes for patients with Gleason scores 8–10 prostate cancer treated with combination brachytherapy, external beam irradiation and hormonal therapy. Int J Radiat Oncol Biol Phys 2008;72: 290.
Han B, Wallner K. Dosimetric and radiographic correlates to prostate brachytherapy-related rectal complications. Int J Cancer 2002;96:372–378.
Merrick G, Butler W, Dorsey A, Lief J, Walbert H, Blatt H. Rectal dosimetric analysis following prostate brachytherapy. Int J Radiat Oncol Biol Phys 1999;43:1021–1027.
Tran A, Wallner K, Merrick G, Seeberger J, Armstrong J, Mueller A, et al. Rectal fistula following prostate brachytherapy. Int J Radiat Oncol Biol Phys 2005;63:150–154.
Snyder K, Stock R, Hong S, Lo Y, Stone N. Defining the risk of developing grade 2 proctitis following 125-I prostate brachytherapy using a rectal dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 2001;50:335–341.
Wallner K, Merrick G, True L, Sheretz T, Sutlief S, Cavanagh W, et al. 20 Gy versus 44 Gy supplemental beam radiation with Pd-103 prostate brachytherapy: early biochemical outcomes from a prospective randomized multi-center trial. Radiother Oncol 2005;75:307–310.
Wust P, Postrach J, Kahmann F, Henkel T, Graf R, Cho C, et al. Postimplantation analysis enables improvement of dose-volume histograms and reduction of toxicity for permanent seed implantation. Int J Radiat Oncol Biol Phys 200871: 28–35.
Mueller A, Wallner K, Merrick G, Ford E, Sutlief S, Cavanagh W, et al. Peri-rectal seeds as a risk factor for prostate brachytherapy-related rectal bleeding. Int J Radiat Oncol Biol Phys 2004;59:1047–1052.
Waterman F, Dicker A. Probability of late rectal morbidity in I-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys 2003;55:342–353.
Zelefsky M, Yamada J, Cohen G, Venkatraman E, Fung A, Furhang E, et al. Postimplantation dosimetric analysis of permanent transperineal prostate implantation: improved dose distributions with an intraoperative computer-optimized conformal planning technique. Int J Radiat Oncol Biol Phys 2000;48:601–608.
Hilts M, Spadinger I, Keyes M. Comparison of methods for calculating rectal dose after 125I prostate brachytherapy implant. Int J Radiat Oncol Biol Phys 2002;53:775–785.
Hu K, Wallner K. Clinical course of rectal bleeding following I-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys 1998;41:263–265.
Iversen P, Bak M, Juul N, Laursen F, Maase H, Nielsen L, et al. Ultrasonically guided iodine-125 seed implantation with external radiation in management of localized prostatic carcinoma. Urology 1989;34:181–186.
Zeitlin S, Sherman J, Raboy A, Lederman G, Albert P. High dose combination radiotherapy for the treatment of localized prostate cancer. J Urol 1998;160:91–96.
Patel J, Worthen R, Abadir R, Weaver D, Weinstein S, Ross G. Late results of combined iodine-125 and external beam radiotherapy in carcinoma of prostate. Urology 1990;36: 27–30.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Aoki, M., Miki, K., Sasaki, H. et al. Evaluation of rectal bleeding factors associated with prostate brachytherapy. Jpn J Radiol 27, 444–449 (2009). https://doi.org/10.1007/s11604-009-0369-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-009-0369-5