Korean J Urol.  2015 Sep;56(9):637-643. 10.4111/kju.2015.56.9.637.

Difference in the rate of rectal complications following prostate brachytherapy based on the prostate-rectum distance and the prostate longitudinal length among early prostate cancer patients

• Kang MH
• Yu YD
• Shin HS
• Oh JJ
• Park DS

• KMID: 2344102
• DOI: http://doi.org/10.4111/kju.2015.56.9.637

Abstract

PURPOSE
To investigate the difference in rectal complications rate following prostate low dose rate (LDR) brachytherapy based on prostate-rectum distance and prostate longitudinal length among early prostate cancer patients.
MATERIALS AND METHODS
From March 2008 to February 2013, 245 prostate cancer patients with a Gleason score < or =7 were treated with 125-I LDR brachytherapy. Among them, 178 patients with prostate volume 20-35 mL and a follow-up period > or =6 months were evaluated for radiation proctitis. Magnetic resonance imaging (MRI) was performed for a prebrachytherapy evaluation, and prostate-rectum distance and prostate longitudinal length were measured. The radiation proctitis was confirmed and graded via colonoscopy based on the radiation therapy oncology group (RTOG) toxicity criteria.
RESULTS
Twenty-three patients received a colonoscopy for proctitis evaluation, and 12 were identified as grade 1 on the RTOG scale. Nine patients were diagnosed as grade 2 and 2 patients were grade 3. No patient developed grade 4 proctitis. The rectal-complication group had a mean prostate-rectum distance of 2.51+/-0.16 mm, while non-rectal-complication control group had 3.32+/-0.31 mm. The grade 1 proctitis patients had a mean prostate-rectum distance of 2.80+/-0.15 mm, which was significantly longer than 2.12+/-0.31 mm of grades 2 and 3 patient groups (p=0.045). All 11 patients of grades 2 and 3 had a prostate longitudinal length of 35.22+/-2.50 mm, which was longer than group 1, but the difference was not statistically significant (p=0.214).
CONCLUSIONS
As the prostate-rectum distance increased, fewer postimplantation rectal symptoms were observed. Patients with a shorter prostate-rectum distance in MRI should receive modified implantation techniques or radical prostatectomy.

Keyword

Brachytherapy; Proctitis; Prostatic neoplasms

MeSH Terms

Aged
Brachytherapy/*adverse effects
Carcinoma/*radiotherapy
Colonoscopy
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Organ Size
Proctitis/diagnosis/*etiology
Prostate/*pathology
Prostatic Neoplasms/*radiotherapy
Radiation Injuries/diagnosis/*etiology
Severity of Illness Index

Figure

• 

  Fig. 1 Radiation proctitis seen on colonoscopy with anterior rectal ulceration.

• 

  Fig. 2 Midsaggital view of pelvic magnetic resonance imaging with types of prostate and rectum shape. (A) Type 1, triangular shape with relatively thick prostate-rectum distance; (B) type 2, inverted bell shape with relatively thin prostate-rectum distance; (C) type 3, ovoid shape with direct contact prostate-rectum (minimal distance). P, prostate; R, rectum; RP, right posterior; RPH, relative peak height; LPF, low pass filter.

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