Rectal morbidity following I-125 prostate brachytherapy in relation to dosimetry

Toshio Ohashi, Atsunori Yorozu, Kazuhito Toya, Shiro Saito, Tetsuo Momma, Hirohiko Nagata, Michio Kosugi

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: To investigate rectal morbidity after I-125 prostate brachytherapy and to analyze predictive factors of rectal morbidity. Methods: A group of 227 consecutive patients with localized prostate cancer were treated with I-125 prostate brachytherapy with or without external beam radiotherapy (EBRT) between September 2003 and January 2005. Rectal morbidity (diarrhea, bleeding and pain) was evaluated using the Radiation Therapy Oncology Group (RTOG) criteria. Dosimetry was based on computerized tomography (CT) scan 1 month post-implant. The clinical, treatmentrelated and dosimetric factors were evaluated for the risk of grade 2 rectal morbidity. Rectal dosimetric factors included the rectal volume that received. 100% and 150% of the prescribed dose, and the maximal rectal dose which was defined as the sum of the minimal dose received by 1% of the rectum volume and the prescribed dose of EBRT. Results: Grade 2 rectal bleeding occurred in 10 (4.4%): for nine patients within the first year and for one patient between the first and second year. Grade 2 diarrhea occurred in one patient (0.4%) within the first year. No patient reported grade 2 pain. In the univariate analysis with grade 2 rectal bleeding, there were significant correlations with number of seeds, supplemental EBRT, and all of the rectal dosimetric parameters. On subsequent multivariate analysis, the only significant factor was the maximal rectal dose (P < 0.001). Rectal dose > 160 Gy was correlated to grade 2 rectal morbidity. All the patients with rectal dose > 160 Gy received EBRT. Conclusions: Manifestations of rectal morbidity are acceptable events after I-125 prostate brachytherapy. Rectal dose-volume histogram for the brachytherapy is a predictive method for assessing the risk of developing grade 2 rectal bleeding. Delivery of the rectal dose should not exceed 160 Gy in order to avoid rectal complications.

Original languageEnglish
Pages (from-to)121-126
Number of pages6
JournalJapanese Journal of Clinical Oncology
Volume37
Issue number2
DOIs
Publication statusPublished - 2007 Feb
Externally publishedYes

Fingerprint

Brachytherapy
Prostate
Morbidity
Radiotherapy
Hemorrhage
Diarrhea
Pain
Radiation Oncology
Rectum
Statistical Factor Analysis
Prostatic Neoplasms
Seeds
Multivariate Analysis
Tomography

Keywords

  • Brachytherapy
  • Iodine-125
  • Proctitis
  • Prostate cancer
  • Rectal bleeding
  • Rectal morbidity

ASJC Scopus subject areas

  • Oncology

Cite this

Rectal morbidity following I-125 prostate brachytherapy in relation to dosimetry. / Ohashi, Toshio; Yorozu, Atsunori; Toya, Kazuhito; Saito, Shiro; Momma, Tetsuo; Nagata, Hirohiko; Kosugi, Michio.

In: Japanese Journal of Clinical Oncology, Vol. 37, No. 2, 02.2007, p. 121-126.

Research output: Contribution to journalArticle

Ohashi, Toshio ; Yorozu, Atsunori ; Toya, Kazuhito ; Saito, Shiro ; Momma, Tetsuo ; Nagata, Hirohiko ; Kosugi, Michio. / Rectal morbidity following I-125 prostate brachytherapy in relation to dosimetry. In: Japanese Journal of Clinical Oncology. 2007 ; Vol. 37, No. 2. pp. 121-126.
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abstract = "Background: To investigate rectal morbidity after I-125 prostate brachytherapy and to analyze predictive factors of rectal morbidity. Methods: A group of 227 consecutive patients with localized prostate cancer were treated with I-125 prostate brachytherapy with or without external beam radiotherapy (EBRT) between September 2003 and January 2005. Rectal morbidity (diarrhea, bleeding and pain) was evaluated using the Radiation Therapy Oncology Group (RTOG) criteria. Dosimetry was based on computerized tomography (CT) scan 1 month post-implant. The clinical, treatmentrelated and dosimetric factors were evaluated for the risk of grade 2 rectal morbidity. Rectal dosimetric factors included the rectal volume that received. 100{\%} and 150{\%} of the prescribed dose, and the maximal rectal dose which was defined as the sum of the minimal dose received by 1{\%} of the rectum volume and the prescribed dose of EBRT. Results: Grade 2 rectal bleeding occurred in 10 (4.4{\%}): for nine patients within the first year and for one patient between the first and second year. Grade 2 diarrhea occurred in one patient (0.4{\%}) within the first year. No patient reported grade 2 pain. In the univariate analysis with grade 2 rectal bleeding, there were significant correlations with number of seeds, supplemental EBRT, and all of the rectal dosimetric parameters. On subsequent multivariate analysis, the only significant factor was the maximal rectal dose (P < 0.001). Rectal dose > 160 Gy was correlated to grade 2 rectal morbidity. All the patients with rectal dose > 160 Gy received EBRT. Conclusions: Manifestations of rectal morbidity are acceptable events after I-125 prostate brachytherapy. Rectal dose-volume histogram for the brachytherapy is a predictive method for assessing the risk of developing grade 2 rectal bleeding. Delivery of the rectal dose should not exceed 160 Gy in order to avoid rectal complications.",
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AU - Ohashi, Toshio

AU - Yorozu, Atsunori

AU - Toya, Kazuhito

AU - Saito, Shiro

AU - Momma, Tetsuo

AU - Nagata, Hirohiko

AU - Kosugi, Michio

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N2 - Background: To investigate rectal morbidity after I-125 prostate brachytherapy and to analyze predictive factors of rectal morbidity. Methods: A group of 227 consecutive patients with localized prostate cancer were treated with I-125 prostate brachytherapy with or without external beam radiotherapy (EBRT) between September 2003 and January 2005. Rectal morbidity (diarrhea, bleeding and pain) was evaluated using the Radiation Therapy Oncology Group (RTOG) criteria. Dosimetry was based on computerized tomography (CT) scan 1 month post-implant. The clinical, treatmentrelated and dosimetric factors were evaluated for the risk of grade 2 rectal morbidity. Rectal dosimetric factors included the rectal volume that received. 100% and 150% of the prescribed dose, and the maximal rectal dose which was defined as the sum of the minimal dose received by 1% of the rectum volume and the prescribed dose of EBRT. Results: Grade 2 rectal bleeding occurred in 10 (4.4%): for nine patients within the first year and for one patient between the first and second year. Grade 2 diarrhea occurred in one patient (0.4%) within the first year. No patient reported grade 2 pain. In the univariate analysis with grade 2 rectal bleeding, there were significant correlations with number of seeds, supplemental EBRT, and all of the rectal dosimetric parameters. On subsequent multivariate analysis, the only significant factor was the maximal rectal dose (P < 0.001). Rectal dose > 160 Gy was correlated to grade 2 rectal morbidity. All the patients with rectal dose > 160 Gy received EBRT. Conclusions: Manifestations of rectal morbidity are acceptable events after I-125 prostate brachytherapy. Rectal dose-volume histogram for the brachytherapy is a predictive method for assessing the risk of developing grade 2 rectal bleeding. Delivery of the rectal dose should not exceed 160 Gy in order to avoid rectal complications.

AB - Background: To investigate rectal morbidity after I-125 prostate brachytherapy and to analyze predictive factors of rectal morbidity. Methods: A group of 227 consecutive patients with localized prostate cancer were treated with I-125 prostate brachytherapy with or without external beam radiotherapy (EBRT) between September 2003 and January 2005. Rectal morbidity (diarrhea, bleeding and pain) was evaluated using the Radiation Therapy Oncology Group (RTOG) criteria. Dosimetry was based on computerized tomography (CT) scan 1 month post-implant. The clinical, treatmentrelated and dosimetric factors were evaluated for the risk of grade 2 rectal morbidity. Rectal dosimetric factors included the rectal volume that received. 100% and 150% of the prescribed dose, and the maximal rectal dose which was defined as the sum of the minimal dose received by 1% of the rectum volume and the prescribed dose of EBRT. Results: Grade 2 rectal bleeding occurred in 10 (4.4%): for nine patients within the first year and for one patient between the first and second year. Grade 2 diarrhea occurred in one patient (0.4%) within the first year. No patient reported grade 2 pain. In the univariate analysis with grade 2 rectal bleeding, there were significant correlations with number of seeds, supplemental EBRT, and all of the rectal dosimetric parameters. On subsequent multivariate analysis, the only significant factor was the maximal rectal dose (P < 0.001). Rectal dose > 160 Gy was correlated to grade 2 rectal morbidity. All the patients with rectal dose > 160 Gy received EBRT. Conclusions: Manifestations of rectal morbidity are acceptable events after I-125 prostate brachytherapy. Rectal dose-volume histogram for the brachytherapy is a predictive method for assessing the risk of developing grade 2 rectal bleeding. Delivery of the rectal dose should not exceed 160 Gy in order to avoid rectal complications.

KW - Brachytherapy

KW - Iodine-125

KW - Proctitis

KW - Prostate cancer

KW - Rectal bleeding

KW - Rectal morbidity

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