Influence of Dose on Risk of Acute Urinary Retention After Iodine-125 Prostate Brachytherapy

• Published in: International journal of radiation oncology, biology, physics Vol. 80; no. 4; pp. 1072 - 1079
• Main Authors: Roeloffzen, Ellen M.A., M.D, Battermann, Jan J., M.D., Ph.D, van Deursen, Marijke J.H., MSc, Monninkhof, Evelyn M., Ph.D, Visscher, Mareije I., M.D, Moerland, Marinus A., Ph.D, van Vulpen, Marco, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.07.2011; Elsevier
• Subjects: Acute Disease; Acute urinary retention; Aged; Analysis of Variance; AUR; BETA DECAY RADIOISOTOPES; Biological and medical sciences; BODY; BRACHYTHERAPY; Brachytherapy - adverse effects; Brachytherapy - instrumentation; Brachytherapy - methods; DAYS LIVING RADIOISOTOPES; DIAGNOSTIC TECHNIQUES; DISEASES; Dose; DOSES; EDEMA; ELECTRON CAPTURE RADIOISOTOPES; GLANDS; Gynecology. Andrology. Obstetrics; HAZARDS; Hematology, Oncology and Palliative Medicine; Humans; INTERMEDIATE MASS NUCLEI; INTERNAL CONVERSION RADIOISOTOPES; IODINE 125; IODINE ISOTOPES; Iodine Radioisotopes - therapeutic use; ISOTOPES; Magnetic Resonance Imaging; Male; Male genital diseases; MALE GENITALS; MATHEMATICS; Medical sciences; MEDICINE; MULTIVARIATE ANALYSIS; NEOPLASMS; Nephrology. Urinary tract diseases; NMR IMAGING; NUCLEAR MEDICINE; NUCLEI; ODD-EVEN NUCLEI; Organ Size; ORGANS; PATHOLOGICAL CHANGES; Prospective Studies; PROSTATE; Prostate - pathology; Prostate brachytherapy; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; RADIATION DOSES; RADIOISOTOPES; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; REGRESSION ANALYSIS; Risk Factors; STATISTICS; SYMPTOMS; THERAPY; Tumor Burden; Tumors; Tumors of the urinary system; ULTRASONOGRAPHY; Urinary Retention - etiology; Urinary system involvement in other diseases. Miscellaneous; Urinary toxicity; URINARY TRACT; Urinary tract. Prostate gland; Urinary toxicity; Acute urinary retention; Prostate cancer; Dose; AUR; Prostate brachytherapy; Urinary system disease; Prostate disease; Toxicity; Malignant tumor; Urinary retention; Radiotherapy; Voiding dysfunction; Treatment; Risk factor; Urogenital system; Male genital diseases; Curietherapy; Prostate; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2010.03.009

Purpose To assess the influence of dose on the risk of acute urinary retention (AUR) after iodine-125 prostate brachytherapy. Methods and Materials Between January 2005 and December 2008, 714 consecutive patients with localized prostate cancer were treated with iodine-125 prostate brachytherapy at our department. All patients completed four imaging studies: magnetic resonance imaging before and 4 weeks after treatment and intraoperative three-dimensional transrectal ultrasonography before and after implantation. The development of AUR was prospectively recorded. The evaluated treatment and dosimetric parameters included prostate volume, number of needles and seeds used, intra- and postoperative prostate edema, percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed dose to the prostate, minimal dose received by 90% of the prostate volume, and percentage of the urethra receiving 100%, 150%, and 200% of the prescribed dose. Logistic regression analysis was used to examine which factors were associated with AUR. Results Of the 714 patients, 57 (8.0%) developed AUR. On univariate analysis, the following treatment and dosimetric factors were significantly associated with AUR: International Prostate Symptom Score (odds ratio [OR], 2.07, per 10-point increase), preimplant prostate volume (OR, 1.06), postimplant prostate volume (OR, 1.04), number of needles used (OR, 1.09), and number of seeds used (OR, 1.03). On multivariate analysis, the only independent predictive factors for AUR were pretreatment prostate volume (OR, 1.05) and International Prostate Symptom Score (OR, 1.76, per 10-point increase). Patients with a pretreatment prostate volume >35 cm3 had a 10.4% risk of developing AUR compared with 5.4% for those with a prostate volume of ≤35 cm3 . No association was found between any of the dosimetric parameters and the development of AUR. Conclusion The radiation dose, within the range studied, did not influence the risk of AUR after iodine-125 prostate brachytherapy. Prostate volume and International Prostate Symptom Score were the most important predictors of AUR.