Teruki Teshima

Rectal bleeding after conformal 3D treatment of prostate cancer: Time to occurrence, response to treatment and duration of morbidity

PURPOSE Rectal bleeding is the most common late sequelae of high-dose 3D conformal treatment (3DCRT) for prostate cancer and may limit attempts to improve local control by dose escalation. The clinical course of this complication is reported including time to onset, response to treatment, duration of morbidity, and multivariate analysis for predictors. METHODS AND MATERIALS From March 1989 to June 1995, 670 patients with prostate cancer were treated with 3DCRT at Fox Chase Cancer Center. Eighty-nine patients developed Grade 2 or Grade 3 complications due to rectal bleeding and are analyzed. Multivariate analysis results for predictors of Grade 2 and 3 rectal bleeding are reported as well as time to development, response to initial and retreatment, and duration of morbidity. RESULTS The median time to occurrence is not significantly different (p = 0.09) for Grade 2 (13 months, range 4-41 months) compared to Grade 3 rectal bleeding (18 months, range 4-40 months), while the corresponding median duration of symptoms was significantly different (p < 0.0001) being 1 month (range 1-12) vs. 10 months (1-34) for Grade 2 and Grade 3 bleeding, respectively. For Grade 2 bleeding, medication or coagulation was highly effective as initial or retreatment resolving 66 of 73 patients. For Grade 3 bleeding, three patients responded without medication following blood transfusion only, while with multiple coagulations and medication 12 of 16 patients improved to < or = Grade 1. Multivariate analysis demonstrates that dose is the only significant factor associated with Grade 2 (p = 0.01) or Grade 3 (p = 0.01) rectal bleeding. Of seven nonresponders to treatment for Grade 2 bleeding, three have died of intercurrent disease at 10, 19, and 26 months, while four are alive with continuing Grade 2 bleeding at 12, 14, 15, and 30 months after onset. The four nonresponders to treatment for Grade 3 bleeding continue to bleed 1, 9, 32, and 35 months after the third coagulation despite continuing care. CONCLUSIONS Chronic rectal bleeding is a sequelae of high-dose conformal treatment of prostate cancer. Grade 2 morbidity responds to medication or limited coagulation (< or = 2) in 90% of patients. Grade 3 morbidity responds to medication and multiple coagulations (> or = 3) in 75% of patients. The chronicity of Grade 3 morbidity is illustrated by a 10-month median duration for response to treatment, with a range of response extending to 34 months. Nonresponders to treatment have continued to bleed up to 35 months after the third coagulation. Appropriate shielding of the rectal mucosa limiting dose to < 72 Gy is required to avoid a high incidence of these complications, as dose is the only significant variable associated with rectal bleeding.

20 years of progress in radiation oncology: Prostate cancer

The Patterns of Care Study in Radiation Oncology has documented United States national averages for the evaluation and treatment of prostate cancer from 1973 to 1994. We report the characteristics of patient populations, treatment characteristics, and outcomes of care.

Comparison of three methods for determining prostate gland volume in anticipation of conformal radiation treatment planning

With the advent of 3-dimensional computed axial tomography simulators (CT sim), more sophisticated conformal radiation treatment planning is possible. In order to estimate the accuracy of prostate volumes calculated by CT sim, the volumes obtained by CT sim and ultrasound (US) and diagnostic CT were compared. From April 1989 to December 1992, 212 prostate cancer patients were treated with conformal techniques guided by diagnostic CT. Fifty of them had their prostate volume determined by transrectal ultrasound (US). The prostate volumes calculated using diagnostic CT and US were compared. From April 1993 to May 1994, 186 patients were treated with conformal technique guided by CT sim. Eighty-three of them had their prostate volumes determined by ultrasound. The prostate volumes were determined using the ellipsoid model for each of the imaging methods (ultrasound, diagnostic CT, CT simulator). An additional integral method was available for determining volume with the CT simulator. The median ellipsoid model volume of the prostate gland was 40.3 cc by US and 54.4 cc by diagnostic CT. Correlation coefficient (r2) was 0.608 (P < 0.001). CT sim: The corresponding median ellipsoid model volumes were 37 cc by US, and 49.8 cc using the ellipsoid model by CT sim. The CT sim volume was 38.1 cc using the integral method. The r2 of the prostate volumes by US and CT sim (integral method) was 0.803 (P < 0.001). The prostate volume calculated using the integral method by CT sim was similar to the volume obtained using the ellipsoid model with US. The ellipsoid model method of calculation was significantly different from the ultrasound volume for both the diagnostic and CT sim method. The ellipsoid model calculation for US and the integral volume calculation for CT sim most closely approximates true gland size. Radiat Oncol Invest 1996;4:74–79.