Abstract:Purpose/Objective: To evaluate the risk of rectal complications in patients undergoing permanent prostate brachytherapy (PPB) for localized prostate cancer. Materials/Methods: A total of 663 patients underwent PPB from September 1995 to September 2002. Of these patients 308 received PPB as monotherapy, 161 underwent neo-adjuvant androgen ablation (NAAD) and PPB, 103 pts received external beam radiation (EBRT) and PPB, and 91 had NAAD with EBRT and PPB. Patients then had routine follow-up and were evaluated for GI complications. Statistical analysis was performed to evaluate risk of rectal complications based upon factors such as age, race, use of NAAD, EBRT, isotope, millicuries of isotope and prostate volume at time of implant. Dose-volume histogram analysis of the rectum was not routinely performed. Results: With a median follow-up of 36.3 months, there has been an overall risk of rectal bleeding of 5.2%. The use of NAAD, age, race, type of isotope, total millicuries and prostate volume did not impact on rectal bleeding rates. The use of EBRT increased the rate of rectal bleeding from 2.6% to 11.7% (p<.01). Overall, the rate of Grade 1 rectal toxicity was 3.5% and the rate of Grade 2 rectal toxicity was 1.7%. The majority of patients with rectal bleeding were treated with local therapies such as steroid creams and suppositories. No patients required transfusions for intractable bleeding. A total of three patients were identified to have rectal/colon cancer. One patient developed a Grade 3/4 complication requiring a colostomy due to a rectal ulceration. Conclusions: The overall risk of rectal bleeding from PPB is 5.2%. There was an increase in rectal bleeding associated with EBRT (2.6% vs. 11.7%). The majority of these patients can be treated conservatively. We routinely recommend complete gastrointestinal work-up to identify non-radiation causes of rectal bleeding after PPB.
Patel MD, R,
Rectal Toxicity Associated with Permanent Prostate Brachytherapy. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3240649.html
