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
강문형, 유영동, 신현수, 오종진, 박동수,
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강문형 ( Kang Moon-Hyung )
CHA University CHA Bundang Medical Center Department of Urology
유영동 ( Yu Young-Dong )
CHA University CHA Bundang Medical Center Department of Urology
신현수 ( Shin Hyun-Soo )
CHA University CHA Bundang Medical Center Department of Radiation Oncology
오종진 ( Oh Jong-Jin )
Seoul National University Bundang Hospital Department of Urology
박동수 ( Park Dong-Soo )
CHA University CHA Bundang Medical Center Department of Urology
KMID : 0358320150560090637
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 ≤7 were treated with 125-I LDR brachytherapy. Among them, 178 patients with prostate volume 20-35 mL and a follow-up period ≥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.
키워드
Brachytherapy; Proctitis; Prostatic neoplasms
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