LATE RECTAL BLEEDING AND GENITOURINARY MORBIDITY AFTER HIGH DOSE RATE BRACHYTHERAPY COMBINED WITH HYPOFRACTIONATED EXTERNAL BEAM RADIOTHERAPY FOR LOCALIZED PROSTATE CANCER
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Purpose: To evaluate late rectal bleeding and genitourinary (GU) morbidity in patients consecutively treated with combined high-dose-rate (HDR) brachytherapy and external beam radiation therapy (EBRT). Materials and Methods: Data from 80 patients treated consecutively from October 2000 to May 2004 were analyzed. The median age was 69 years old, median follow-up 31 months, ranging from 17-59 months. All patients received endocrine therapy before radiation therapy. The patients were divided into low-, intermediate- and high-risk groups (4/24/52 patients) according to the risk factors defined by T-classification, PSA and Gleason score. Fractionation schedules for HDR brachytherapy were prospectively changed, and EBRT was fixed with 3 Gy fractions to 51 Gy. The distribution of fractionation was scheduled as follows; 5 Gy×5 times in 14 patients, 7 Gy×3 times in 19 patients, and 9 Gy×2 times in 47 patients. The rectal bleeding was graded using the toxicity criteria of the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer while the genitourinary morbidities were graded using the toxicity criteria of the Common Terminology Criteria for Adverse Events v.3.0.<br>Results: Grade 2 or worse rectal bleeding developed in 9 patients (11.3%) with the 2-year actuarial probability at 11.2%. Grade 2 and 3 rectal bleeding was recognized in 8 and 1 patients, respectively. Grade 3 morbidity developed in the biopsied sites that were performed in the other hospital. No significant difference was observed in any HDR brachytherapy fractionation schedule. Grade 2 or worse GU morbidities were recognized in 30 patients (37.5%), consisting of 29 Grade 2 patients and 1 Grade 3 patient. Twenty-one patients in Grade 2 morbidity had an increase in the frequency of urination or nocturia, and urethral strictures developed in 3 patients. The 3-year actuarial probability of urethral stricture was 6.0%. One patient experienced Grade 3 incontinent. No Grade 4 GU complications was observed.<br>Conclusion: HDR brachytherapy combined with hypofractionated EBRT for localized prostate cancer is feasible considering severity of late rectal and genitourinary morbidity.
- J Jpn Soc Ther Radiol Oncol
J Jpn Soc Ther Radiol Oncol 19(2), 93-97, 2007-06-25
Japanese Society for Therapeutic Radiology and Oncology