Predictive factors of rectal toxicity after permanent iodine-125 seed implantation: Prospective cohort study in 2339 patients

Norihisa Katayama, Atsunori Yorozu, Shinichiro Maruo, Shinsuke Kojima, Toshio Ohashi, Nobumichi Tanaka, Takashi Kikuchi, Satoshi Higashide, Shiro Saito, Takushi Dokiya, Masanori Fukushima, Hidetoshi Yamanaka

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Abstract

Purpose To evaluate the incidence and the associated factors of rectal toxicity in patients with prostate cancer undergoing permanent seed implantation (PI) with or without external beam radiation therapy (EBRT) in a nationwide prospective cohort study in Japan (J-POPS) during the first 2 years. Methods and Materials A total of 2,339 subjects were available for the analyses. Rectal toxicity was evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results The 3-year cumulative incidence for grade ≥2 rectal toxicity was 2.88%, 1.76%, and 6.53% in all subjects, PI group and EBRT combination therapy group, respectively. On multivariate analysis, among all subjects, grade ≥2 rectal toxicity was associated with rectal volumes receiving 100% of the prescribed dose (R100; p < 0.0001) and EBRT combination therapy (p = 0.0066). R100 in the PI group (p = 0.0254), and R100 (p = 0.0011) and interactive planning (p = 0.0267) in the EBRT combination therapy group were also associated with grade ≥2 toxicity. The 3-year cumulative incidence of grade ≥2 rectal toxicity was 3.80% and 1.37% for R100 ≥ 1 mL and R100 < 1 mL, respectively, in the PI group (p = 0.0068), and 14.09% and 5.52% for R100 ≥ 1 mL and R100 < 1 mL, respectively, in the EBRT combination therapy group (p = 0.0070). Conclusions Rectal toxicity was relatively rare in this study compared with previous reports. For Japanese prostate cancer patients, R100 < 1 mL in both PI and EBRT combination therapy groups and interactive planning in EBRT combination therapy group may be effective in decreasing the incidence of rectal toxicity.

Original languageEnglish
Pages (from-to)736-745
Number of pages10
JournalBrachytherapy
Volume15
Issue number6
DOIs
Publication statusPublished - Nov 1 2016

Keywords

  • Brachytherapy
  • Dose-volume histogram parameters
  • External beam radiation therapy
  • Interactive planning
  • Prostate cancer
  • Rectal toxicity

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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    Katayama, N., Yorozu, A., Maruo, S., Kojima, S., Ohashi, T., Tanaka, N., Kikuchi, T., Higashide, S., Saito, S., Dokiya, T., Fukushima, M., & Yamanaka, H. (2016). Predictive factors of rectal toxicity after permanent iodine-125 seed implantation: Prospective cohort study in 2339 patients. Brachytherapy, 15(6), 736-745. https://doi.org/10.1016/j.brachy.2016.09.001