Abstract
Purpose
To compare dose–volume histogram variables for the internal and external urinary sphincters
(IUS/EUS) with urinary quality of life after prostate brachytherapy.
Methods and Materials
Subjects were 42 consecutive men from a prospective study of brachytherapy as monotherapy
with 125I for intermediate-risk localized prostate cancer. No patient received hormonal therapy.
Preplanning constraints included prostate V100 higher than 95%, V150 lower than 60%, and V200 lower than 20% and rectal R100 less than 1 cm3. Patients completed the Expanded Prostate Cancer Index Composite quality-of-life
questionnaire before and at 1, 4, 8, and 12 months after implantation, and urinary
domain scores were analyzed. All structures including the IUS and EUS were contoured
on T2-weighted MRI at day 30, and doses received were calculated from identification
of seeds on CT. Spearman's (nonparametric) rank correlation coefficient (ρ) was used for statistical analyses.
Results
Overall urinary morbidity was worst at 1 month after the implant. Urinary function
declined when the IUS V285 was 0.4% (ρ=−0.32, p=0.04); bother worsened when the IUS V35 was 99% (ρ=−0.31, p=0.05) or the EUS V240 was 63% (ρ=−0.31, p=0.05); irritation increased when the IUS V35 was 95% (ρ=−0.37, p=0.02) and the EUS V265 was 24% (ρ=−0.32, p=0.04); and urgency worsened when the IUS V35 was 99.5% (ρ=−0.38, p=0.02). Incontinence did not correlate with EUS or IUS dose.
Conclusions
Doses to the IUS and EUS on MRI/CT predicted worse urinary function, with greater
bother, irritative symptoms, and urgency. Incorporating MRI-based dose–volume histogram
analysis into the treatment planning process may reduce acute urinary morbidity after
brachytherapy.
Keywords
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Article info
Publication history
Published online: March 04, 2013
Accepted:
October 19,
2012
Received in revised form:
October 7,
2012
Received:
July 23,
2012
Footnotes
Financial disclosure: This work was supported in part by the National Institutes of Health Cancer Center Support Grant CA16672.
Conflicts of interest notification: No conflicts to disclose.
Identification
Copyright
© 2013 Published by Elsevier Inc.
