TY - JOUR
T1 - Predictive factors of rectal hemorrhage in patients with localized prostate cancer who underwent low-dose-rate brachytherapy
AU - Taniguchi, Tomoki
AU - Iinuma, Koji
AU - Kato, Daiki
AU - Takai, Manabu
AU - Maekawa, Yuka Muramatsu
AU - Nakane, Keita
AU - Mizutani, Kosuke
AU - Tsuchiya, Tomohiro
AU - Nakano, Masahiro
AU - Kato, Taku
AU - Ito, Masaya
AU - Kumano, Tomoyasu
AU - Matsuo, Masayuki
AU - Koie, Takuya
N1 - Publisher Copyright:
© 2020, Japan Society of Clinical Oncology.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background: This study aimed to evaluate the association between clinical covariates or the prescribed radiation dose for the prostate and rectal hemorrhage in patients with prostate cancer (PCa) who received iodine-125 low-dose-rate brachytherapy (LDR-BT group) or the combination of LDR-BT and external beam radiation therapy (CMT group). Methods and materials: In this retrospective study, we reviewed the clinical records of 298 consecutive PCa patients with clinical stage T1c/T2 who underwent LDR-BT between August 2004 and August 2016 at a single institution. The prescribed minimum peripheral doses were 145 Gy for the LDR-BT group and 104 Gy for the CMT group. The dosimetric parameters analyzed were minimal dose received by 90% of the prostate gland, biologically effective dose, and rectal volume receiving 100% (RV100) or 150% of the prescribed dose. The endpoint of this study was the onset of any-grade clinical rectal hemorrhage after treatment. Results: The median follow-up period was 6.8 years. The 5-year overall survival rate was found to be 98.3%, and two patients (0.7%) reported biochemical recurrence during follow-up period. A total of 33 patients (11%) experienced rectal hemorrhage. However, ≥ grade 2 rectal hemorrhage occurred in eight patients (2.7%). On multivariate analysis, CMT, RV100 ≥ 0.66 mL, and hemorrhoids before treatment were identified as predictors of rectal hemorrhage after radiation therapy. Conclusions: Maximal reduction of the rectal dose seems very important to prevent serious rectal hemorrhage. In addition, we should consider the risk of rectal toxicities in patients with abnormalities in the rectal mucosa, especially hemorrhoids.
AB - Background: This study aimed to evaluate the association between clinical covariates or the prescribed radiation dose for the prostate and rectal hemorrhage in patients with prostate cancer (PCa) who received iodine-125 low-dose-rate brachytherapy (LDR-BT group) or the combination of LDR-BT and external beam radiation therapy (CMT group). Methods and materials: In this retrospective study, we reviewed the clinical records of 298 consecutive PCa patients with clinical stage T1c/T2 who underwent LDR-BT between August 2004 and August 2016 at a single institution. The prescribed minimum peripheral doses were 145 Gy for the LDR-BT group and 104 Gy for the CMT group. The dosimetric parameters analyzed were minimal dose received by 90% of the prostate gland, biologically effective dose, and rectal volume receiving 100% (RV100) or 150% of the prescribed dose. The endpoint of this study was the onset of any-grade clinical rectal hemorrhage after treatment. Results: The median follow-up period was 6.8 years. The 5-year overall survival rate was found to be 98.3%, and two patients (0.7%) reported biochemical recurrence during follow-up period. A total of 33 patients (11%) experienced rectal hemorrhage. However, ≥ grade 2 rectal hemorrhage occurred in eight patients (2.7%). On multivariate analysis, CMT, RV100 ≥ 0.66 mL, and hemorrhoids before treatment were identified as predictors of rectal hemorrhage after radiation therapy. Conclusions: Maximal reduction of the rectal dose seems very important to prevent serious rectal hemorrhage. In addition, we should consider the risk of rectal toxicities in patients with abnormalities in the rectal mucosa, especially hemorrhoids.
KW - Brachytherapy
KW - Hemorrhoids
KW - Prostate cancer
KW - Rectal hemorrhage
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U2 - 10.1007/s10147-020-01713-x
DO - 10.1007/s10147-020-01713-x
M3 - Article
C2 - 32500469
AN - SCOPUS:85086013704
SN - 1341-9625
VL - 25
SP - 1711
EP - 1717
JO - International Journal of Clinical Oncology
JF - International Journal of Clinical Oncology
IS - 9
ER -