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Brachytherapy. 2015 Mar-Apr;14(2):148-59. doi: 10.1016/j.brachy.2014.11.005. Epub 2014 Dec 13.

Late rectal toxicity after low-dose-rate brachytherapy: incidence, predictors, and management of side effects.

Author information

1
Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
2
Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA. Electronic address: PKupelian@mednet.ucla.edu.

Abstract

As clinical outcomes for patients with clinically localized prostate cancer continue to improve, patients and physicians are increasing making treatment decisions based on concerns regarding long-term morbidity. A primary concern is late radiation proctitis, a clinical entity embodied by various signs and symptoms, ranging from diarrhea to rectal fistulas. Here, we present a comprehensive literature review examining the clinical manifestations and pathophysiology of late radiation proctitis after low-dose-rate brachytherapy (BT), as well as its incidence and predictors. The long-term risks of rectal bleeding after BT are on the order of 5-7%, whereas the risks of severe ulceration or fistula are on the order of 0.6%. The most robust predictor appears to be the volume of rectum receiving the prescription dose. In certain situations (e.g., salvage setting, for patients with increased radiosensitivity, and following aggressive biopsy after BT), the risk of these severe toxicities may be increased by up to 10-fold. A variety of excellent management options exist for rectal bleeding, with endoscopic methods being the most commonly used.

KEYWORDS:

Low-dose-rate brachytherapy; Prostate cancer; Radiation proctitis; Rectal bleeding; Rectal toxicity

PMID:
25516492
DOI:
10.1016/j.brachy.2014.11.005
[Indexed for MEDLINE]

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