Risk factors for rectal bleeding associated with I-125 brachytherapy for prostate cancer

Abstract

The purpose of this study was to determine the risk factors for rectal bleeding after prostate brachytherapy. Between April 2005 and September 2009, 89 patients with T1c-2cN0M0 prostate cancer were treated with permanent I-125 seed implantation alone. The prostate prescription dose was 145 Gy, and the grade of rectal bleeding was scored according to the Common Terminology Criteria for Adverse Events version 4.0. Post-treatment planning was performed with fusion images of computerized tomography and magnetic resonance imaging 4–5 weeks after brachytherapy. Patient characteristics and dosimetric parameters were evaluated to determine risk factors for bleeding. The calculated parameters included the rectal volume in cubic centimeters that received >50–200% of the prescribed dose (RV50–200) and the minimal doses received by 1–30% of the rectal volume (RD1–30). The median follow-up time was 42 months (ranging 18–73 months). Grade 1 rectal bleeding occurred in 24 (27.0%) patients, but no Grade 2 or severe bleeding was observed. Usage of anticoagulants had a significant correlation with the occurrence of bleeding (P = 0.007). The RV100–150 and RD1–10 were significantly higher in patients with rectal bleeding than in those without bleeding. The RV100 was identified as a possible threshold value; the 3-year rectal bleeding rate in patients with an RV100 > 1.0 cm3 was 36%, whereas that with an RV100 ≤ 1.0 cm3 was 14% (P < 0.05). Although no Grade 2 morbidity developed in this study, the RV100 should be kept below 1.0 cm3, especially in additional dose-escalated brachytherapy.

Prostate brachytherapy in Ghana: our initial experience

“…The reported incidence of this complication is less than 0.1% [36, 37], and most cases occurred following rectal instrumentation or rectal biopsies after seed implantation [38] as occurred in our patient. This can be mitigated with the education of patients and rectal surgeons.…”

Late rectal toxicity after low-dose-rate brachytherapy: Incidence, predictors, and management of side effects

“…The volume of rectum receiving 100% of the prescription dose (V 100 ) appears to be a reliable predictor of significant late rectal toxicity, emerging as a significant predictor in nine studies, including the two largest that reviewed dosimetric data (10,12,16,17,21,24,27,28,41). Some studies have identified other parameters, such as maximum rectal dose, as significant predictors of rectal toxicity (7,20,25,31,39).…”

“…(17,27,31,59)) and others reporting dosimetry from CTs obtained at least a month after implantation (e.g., Refs. (7,10,12,21,39,41)). Investigators have also variably defined the rectal organ at risk as the outer rectal wall, inner rectal wall, or entire rectum as a solid structure.…”

Long-Term Endoscopic Follow-Up of Patients with Chronic Radiation Proctopathy after Brachytherapy for Prostate Cancer

“…However, in the present study, no difference was observed in the use of antithrombotic therapy. The use of antithrombotic therapy also results in a rectal bleeding risk after BT or EBRT monotherapy [ 16 , 19 ]; hence, the limited number of patients in the present study was a possible reason for this difference in results compared to previous studies. In addition, ADT was performed as neoadjuvant therapy and it did not affect rectal bleeding.…”