Rectal complications associated with transperineal interstitial brachytherapy for prostate cancer Journal Article

Authors: Gelblum, D. Y.; Potters, L.
Article Title: Rectal complications associated with transperineal interstitial brachytherapy for prostate cancer
Abstract: Purpose: As transperineal interstitial permanent prostate brachytherapy (TIPPB) grows in acceptance as an option in the treatment of organ-confined prostate cancer, its associated toxicities are being defined. This clinical report documents rectal toxicity from a large cohort of men treated by a single practitioner for adenocarcinoma of the prostate. Methods and Materials: Eight hundred twenty-five men were treated from September 1992 to September 1998 with TIPPB. One hundred-forty were treated in conjunction with external beam irradiation (EBRT) and 685 with TIPPB alone. All patients were implanted under real-time ultrasound guidance. No dose-volume histogram analysis was performed for this study. All patients were followed at 5 weeks after the procedure, then every 3-6 months thereafter. Rectal morbidity was graded by a modified RTOG toxicity scale. Therapy to control symptoms was recommended on an individual basis. Results: The median follow-up for the cohort is 48 months. A total of 77 patients (9.4%) reported Grade 1 toxicity at some time following an implant whereas 54 patients (6.6%) reported Grade 2 toxicity. The peak post-TIPPB time for experiencing rectal toxicity was 8 months at which time Grade 1 and 2 rectal toxicity was reported in 9.5% of the patients. This improved over the subsequent months and resolved in all patients by 312 years. Four patients (0.5%) reported Grade 3 rectal toxicity with rectal ulceration identified on colonoscopy at 1 year from implant. Two of the four patients had colonic manipulation in the radiated portion of the colon which subsequently caused it to bleed. None of the patients required blood product transfusion. In 3 of the 4 patients the Grade 3 rectal toxicity has resolved spontaneously and 1 patient continues to heal at the time of this report. No patient required hospitalization or surgical intervention.Conclusion: TIPPB is a tolerable and acceptable treatment option when used alone in early-stage, organ-confined adenocarcinoma of the prostate and in conjunction with EBRT in more advanced disease. This clinical report adds to the growing literature regarding the potential morbidity associated with this procedure and indicates that serious rectal injury is rare. Copyright (C) 2000 Elsevier Science Inc.
Keywords: adult; treatment outcome; aged; aged, 80 and over; middle aged; major clinical study; clinical trial; gastrointestinal hemorrhage; follow-up studies; adenocarcinoma; cohort studies; morbidity; ultrasound; prostate cancer; prostatic neoplasms; disease severity; radiation injuries; brachytherapy; technique; palladium; ulcer; rectum; rectum hemorrhage; perineum; iodine; beam therapy; rectal diseases; rectum disease; rectal injury; humans; human; male; priority journal; article
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 48
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2000-08-01
Start Page: 119
End Page: 124
Language: English
DOI: 10.1016/s0360-3016(00)00632-5
PUBMED: 10924980
PROVIDER: scopus
Notes: Export Date: 18 November 2015 -- Source: Scopus
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MSK Authors
  1. Daphna Y Gelblum
    87 Gelblum
  2. Louis Potters
    38 Potters