Predictive factors of rectal hemorrhage in patients with localized prostate cancer who underwent low-dose-rate brachythe
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ORIGINAL ARTICLE
Predictive factors of rectal hemorrhage in patients with localized prostate cancer who underwent low‑dose‑rate brachytherapy Tomoki Taniguchi1 · Koji Iinuma1 · Daiki Kato1 · Manabu Takai1 · Yuka Muramatsu Maekawa1 · Keita Nakane1 · Kosuke Mizutani1 · Tomohiro Tsuchiya1 · Masahiro Nakano2 · Taku Kato3 · Masaya Ito4 · Tomoyasu Kumano4 · Masayuki Matsuo4 · Takuya Koie1 Received: 20 March 2020 / Accepted: 22 May 2020 © Japan Society of Clinical Oncology 2020
Abstract Background This study aimed to evaluate the association between clinical covariates or the prescribed radiation dose for the prostate and rectal hemorrhage in patients with prostate cancer (PCa) who received iodine-125 low-dose-rate brachytherapy (LDR-BT group) or the combination of LDR-BT and external beam radiation therapy (CMT group). Methods and materials In this retrospective study, we reviewed the clinical records of 298 consecutive PCa patients with clinical stage T1c/T2 who underwent LDR-BT between August 2004 and August 2016 at a single institution. The prescribed minimum peripheral doses were 145 Gy for the LDR-BT group and 104 Gy for the CMT group. The dosimetric parameters analyzed were minimal dose received by 90% of the prostate gland, biologically effective dose, and rectal volume receiving 100% (RV100) or 150% of the prescribed dose. The endpoint of this study was the onset of any-grade clinical rectal hemorrhage after treatment. Results The median follow-up period was 6.8 years. The 5-year overall survival rate was found to be 98.3%, and two patients (0.7%) reported biochemical recurrence during follow-up period. A total of 33 patients (11%) experienced rectal hemorrhage. However, ≥ grade 2 rectal hemorrhage occurred in eight patients (2.7%). On multivariate analysis, CMT, RV100 ≥ 0.66 mL, and hemorrhoids before treatment were identified as predictors of rectal hemorrhage after radiation therapy. Conclusions Maximal reduction of the rectal dose seems very important to prevent serious rectal hemorrhage. In addition, we should consider the risk of rectal toxicities in patients with abnormalities in the rectal mucosa, especially hemorrhoids. Keywords Prostate cancer · Brachytherapy · Rectal hemorrhage · Hemorrhoids
Introduction Prostate cancer (PCa) is the second most common cancer and fifth leading cause of cancer-specific mortality among men worldwide [1]. In Japan, PCa is the fourth most common malignancy in men, and the Japanese National Cancer * Koji Iinuma kiinuma@gifu‑u.ac.jp 1
Department of Urology, Graduate School of Medicine, Gifu University, 1‑1 Yanagido, Gifu 501‑1194, Japan
2
Department of Urology, Gifu Prefectural General Medical Center, 4‑6‑1 Noisiki, Gifu 500‑8717, Japan
3
Department of Urology, Asahi University Hospital, 3‑23 Hasimotocho, Gifu 500‑8523, Japan
4
Department of Radiology, Graduate School of Medicine, Gifu University, 1‑1 Yanagido, Gifu 501‑1194, Japan
Institute reported that approximately 78,400 men were newly diagnosed with PCa in 2018 [2]. Based on systematic review an
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