Clinical and dosimetric factors associated with acute rectal toxicity in patients treated with 131Cs brachytherapy for prostate cancer•
Received 22 July 2009; received in revised form 28 August 2009; accepted 17 September 2009. published online 29 January 2010. Corrected Proof
Abstract
Purpose
131Cs has been recently introduced for use in prostate brachytherapy. We wished to identify clinical and dosimetric factors associated with acute bowel/rectal toxicity in patients treated with 131Cs.
Methods and Materials
Patients treated with 131Cs prostate brachytherapy at the University of Pittsburgh were asked to complete expanded prostate cancer index composite surveys preoperatively and at 2–4 weeks and 3 months postimplant. We identified patients who experienced acute and persistent acute bowel toxicity to determine if any factors could correlate with either situation.
Results
One hundred six patients were treated with 131Cs from September 2006 to May 2008. Thirty-eight percent of patients met our criteria for patient-appreciated acute bowel symptoms. On multivariate analysis, the volume of rectum receiving 50% of the prescribed dose (R-V50; 4.1 vs. 2.6cc, p=0.01), R-V75 (1.3 vs. 0.62cc, p=0.01), the percentage of the prescribed dose received by 1cc of the rectum (R-D-1cc; 75% vs. 64%, p=0.02), and R-D-2cc (63% vs. 54%, p=0.003) were found to be factors associated with a greater risk of severe acute bowel toxicity. At 3-month followup, 28% of patients had persistent acute bowel toxicity. On multivariate analysis, no factors were identified that correlated with persistent acute bowel toxicity.
Conclusions
This study identifies R-V50, R-V75, R-D-1cc, and R-D-2cc as factors associated with patient-appreciated acute rectal toxicity. We are performing dosimetric analysis to determine the optimal distance for the posterior needles from the prostate–rectal interface to decrease rectal dose while still maintaining adequate coverage of prostate.
1Department of Radiation Oncology, University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh, PA
2Department of Urology, University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh, PA
Corresponding author. Department of Radiation Oncology, University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213. Tel.: 412-641-4600; fax: 412-641-1971.
• Presented at the 30th Annual Meeting of the American Brachytherapy Society, May 31 to June 2, 2009, Toronto, Ontario, Canada.
ABSTRACT
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