Long-Term Patient-Reported Rectal Bleeding and Bowel-Related Quality of Life After Cs-131 Prostate Brachytherapy
| Autor: | Ryan P. Smith, Ronald M. Benoit, Sushil Beriwal, Diane C. Ling, Katherine S. Chen |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Time Factors Combination therapy medicine.medical_treatment Brachytherapy 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Prevalence medicine Humans Radiology Nuclear Medicine and imaging Cumulative incidence Patient Reported Outcome Measures Prospective Studies Aged Aged 80 and over Univariate analysis Radiation Proportional hazards model business.industry Incidence Incidence (epidemiology) Hazard ratio Rectum Middle Aged Surgery Oncology Cesium Radioisotopes 030220 oncology & carcinogenesis Quality of Life Regression Analysis Gastrointestinal Hemorrhage business Prostate brachytherapy Follow-Up Studies |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 104:622-630 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2019.02.056 |
| Popis: | There is limited long-term data on outcome and side effects of Cs-131 prostate brachytherapy and minimal patient-reported data on rectal bleeding with any isotope. We aimed to describe the incidence, prevalence, and predictors of late patient-reported rectal bleeding after Cs-131 brachytherapy.We reviewed a prospectively collected database of 620 men treated with Cs-131 prostate brachytherapy. Of 620 patients, 390 (62.9%) received brachytherapy as monotherapy; the remainder received combination therapy with external beam radiation therapy (EBRT). Patients were administered Expanded Prostate Cancer Index Composite questionnaires preoperatively and postoperatively at each follow-up visit. The primary outcome was late rectal bleeding, defined as rectal bleeding reported at the 6-month follow-up or later. Clinically significant rectal bleeding was defined as occurring more than "rarely," and clinically significant bother from rectal bleeding was defined as considering bleeding more than a "very small problem." Univariate and multivariate Cox regression were performed to identify factors predictive for rectal bleeding.With a median follow-up time of 48 months, the cumulative incidence of clinically significant late rectal bleeding was 12.4%, with 15.2% reporting clinically significant bother from bleeding. At the time of last follow-up, the prevalence of clinically significant rectal bleeding and bother were 4.0% and 4.7%, respectively. On univariate analysis, acute clinically significant rectal bleeding, defined as occurring within the first 6 months (P = .001) and combination therapy with EBRT (P = .001) predicted for clinically significant late rectal bleeding. On multivariate analysis, both EBRT (P = .001; hazard ratio, 2.50; 95% confidence interval, 1.58-3.94) and acute rectal bleeding (P .001; hazard ratio, 3.11; 95% confidence interval, 1.75-5.53) remained significant predictors for late rectal bleeding.Prostate brachytherapy with Cs-131 is well tolerated in the long term. Although the incidence of clinically significant patient-reported late rectal bleeding was 12.4%, the prevalence at last follow-up was only 4.0%, suggesting that this problem tends to resolve. |
| Databáze: | OpenAIRE |
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