Gastrointestinal toxicity of transperineal interstitial prostate brachytherapy

• Published in: International journal of radiation oncology, biology, physics Vol. 53; no. 1; pp. 99 - 103
• Main Authors: Kang, Song K, Chou, Rachel H, Dodge, Richard K, Clough, Robert W, Kang, Hi-Sung L, Hahn, Carol A, Whitehurst, Arthur W, Buckley, Niall J, Kim, Jay H, Joyner, Raymond E, Montana, Gustavo S, Ingram, Sally S, Anscher, Mitchell S
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2002; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Brachytherapy; Brachytherapy - adverse effects; Brachytherapy - methods; Complications; Humans; Iodine Radioisotopes - therapeutic use; Male; Medical sciences; Middle Aged; Palladium - therapeutic use; Prospective Studies; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - radiotherapy; Radiation Injuries - complications; Radiation therapy and radiosensitizing agent; Radioisotopes - therapeutic use; Rectal; Rectal Diseases - etiology; Regression Analysis; Treatment with physical agents; Treatment. General aspects; Tumors; Brachytherapy; Rectal; Complications; Prostate cancer; Human; Interstitial radiotherapy; Urinary system disease; Iatrogenic; Rectal disease; Prostate disease; Male; Malignant tumor; Radiotherapy; Perineum; Transperineal route; Treatment; Digestive diseases; Intestinal disease; Complication; Male genital diseases; Curietherapy; Prostate
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/S0360-3016(01)02811-5

Purpose: To characterize the severity and time course of rectal toxicity following transperineal prostate brachytherapy using prospectively recorded data, and to determine factors associated with toxicity. Methods and Materials: One hundred thirty-four patients with prostate cancer treated with transperineal brachytherapy from 1997 to 1999 had rectal toxicity data available for analysis. Patients with Gleason score (GS) > 6, prostate-specific antigen (PSA) > 6, or stage > T2a were treated initially with external beam radiation therapy followed by brachytherapy boost; patients with none of these features were treated with brachytherapy alone. Both iodine-125 and palladium-103 sources were used, and loaded according to a modified Quimby distribution. At each follow-up, toxicity was recorded according to a modified RTOG gastrointestinal scale. Results: Thirty-nine percent of patients experienced gastrointestinal toxicity, mostly Grade 1. Median duration of symptoms was 6 months. Two patients experienced Grade 3 toxicity, both of whom had minimal symptoms until their 12-month follow-up. There was no Grade 4 or 5 toxicity. The addition of external beam radiation therapy ( p = 0.003), higher clinical stage ( p = 0.006), and Caucasian race ( p = 0.01) were associated with increased incidence of toxicity. Conclusion: Most patients with rectal toxicity have very mild symptoms. There is a small risk of severe late toxicity. External beam radiation, higher stage, and race are associated with toxicity.