Predictive factors of rectal hemorrhage in patients with localized prostate cancer who underwent low-dose-rate brachytherapy

Tomoki Taniguchi, Koji Iinuma, Daiki Kato, Manabu Takai, Yuka Muramatsu Maekawa, Keita Nakane, Kosuke Mizutani, Tomohiro Tsuchiya, Masahiro Nakano, Taku Kato, Masaya Ito, Tomoyasu Kumano, Masayuki Matsuo, Takuya Koie

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1711-1717
Number of pages7
JournalInternational Journal of Clinical Oncology
Issue number9
Publication statusPublished - 01-09-2020
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hematology
  • Oncology


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