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Abstract
Purpose
Hemorrhagic radiation proctitis (HRP) is a potential complication of prostate brachytherapy.
We sought to determine the incidence and clinical course of hemorrhagic radiation
proctitis after iodine-125 (125I) prostate brachytherapy.
Patients and Methods
Between 1995 and 2003, 221 consecutive patients were treated at the Barrett Cancer
Center with permanent 125I seed implantation for presumed localized adenocarcinoma of the prostate. No patients
received EBRT. All cases of HRP were confirmed by colonoscopy. Median follow-up was
52 months. All patients were evaluated for HRP using a 5-grade rectal bleeding scale
developed by the Radiation Therapeutic Oncology Group.
Results
Thirty-three patients experienced grade ≤ 1 toxicity at some point after treatment.
Twenty patients developed grade 2 toxicity, 9 developed grade 3, and 2 developed grade
4. The median time to onset of symptoms of HRP was 14 months. The incidence of HRP
had a bimodal temporal onset, with a peak seen at 4 months and a second larger peak
at 16 months. Peak toxicity occurred at 18 months after the onset of rectal bleeding,
after which there was a sharp decline in toxicity.
Conclusion
This study demonstrates tolerable rectal morbidity after transperineal prostate brachytherapy
of the prostate. Hemorrhagic radiation proctitis occurring after brachytherapy for
prostate cancer is usually self-limiting and frequently resolves without treatment
or with minor medical treatment. Patients develop HRP soon after treatment or after
a delay in treatment. Symptoms appear to peak 18 months after the onset of HRP.
Key words
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Article Info
Publication History
Accepted:
September 13,
2007
Received in revised form:
September 13,
2007
Received:
April 2,
2007
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Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
