Incidence and Clinical Course of Hemorrhagic Radiation Proctitis After Iodine-125 Prostate Brachytherapy

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      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.


      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.


      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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        • Saclarides TJ
        • King DG
        • Franklin JL
        • et al.
        Formalin instillation for refractory radiation-induced hemorrhagic proctitis. Report of 16 patients.
        Dis Colon Rectum. 1996; 39: 196-199
        • Cunningham IG
        The management of radiation proctitis.
        Aust N Z J Surg. 1980; 50: 172-178
        • Deitel M
        • Vasic V
        Major intestinal complications of radiotherapy.
        Am J Gastroenterol. 1979; 72: 65-70
      1. Plans and Priorities for Cancer Research [Web site].
        (Accessed July 1, 2006)
        • Beyer DC
        • Priestley Jr, JB
        Biochemical disease-free survival following 125I prostate implantation.
        Int J Radiat Oncol Biol Phys. 1997; 37: 559-563
        • Ragde H
        • Korb LJ
        • Elgamal AA
        • et al.
        Modern prostate brachytherapy. Prostate specific antigen results in 219 patients with up to 12 years of observed follow-up.
        Cancer. 2000; 89: 135-141
        • Kitta T
        • Shinohara N
        • Shirato H
        • et al.
        The treatment of chronic radiation proctitis with hyperbaric oxygen in patients with prostate cancer.
        BJU Int. 2000; 85: 372-374
        • Otchy DP
        • Nelson H
        Radiation injuries of the colon and rectum.
        Surg Clin North Am. 1993; 73: 1017-1035
        • Zinicola R
        • Rutter MD
        • Falasco G
        • et al.
        Haemorrhagic radiation proctitis: endoscopic severity may be useful to guide therapy.
        Int J Colorectal Dis. 2003; 18: 439-444
        • Gelblum DY
        • Potters L
        Rectal complications associated with transperineal interstitial brachytherapy for prostate cancer.
        Int J Radiat Oncol Biol Phys. 2000; 48: 119-124
        • Teshima T
        • Hanks GE
        • Hanlon AL
        • et al.
        Rectal bleeding after conformal 3D treatment of prostate cancer: time to occurrence, response to treatment and duration of morbidity.
        Int J Radiat Oncol Biol Phys. 1997; 39: 77-83
        • Donner CS
        Pathophysiology and therapy of chronic radiation-induced injury to the colon.
        Dig Dis. 1998; 16: 253-261
        • Babb RR
        Radiation proctitis: a review.
        Am J Gastroenterol. 1996; 91: 1309-1311
        • Hu K
        • Wallner K
        Clinical course of rectal bleeding following I-125 prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 1998; 41: 263-265
        • Merrick GS
        • Butler WM
        • Dorsey AT
        • et al.
        Rectal dosimetric analysis following prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 1999; 43: 1021-1027
        • Kang SK
        • Chou RH
        • Dodge RK
        • et al.
        Gastrointestinal toxicity of transperineal interstitial prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 2002; 53: 99-103
        • Schultheiss TE
        • Lee WR
        • Hunt MA
        • et al.
        Late GI and GU complications in the treatment of prostate cancer.
        Int J Radiat Oncol Biol Phys. 1997; 37: 3-11