Skip to main content Accessibility help
×
Home

Late rectal bleeding after volumetric-modulated arc therapy for localised prostatic cancer

  • Yutaka Naoi (a1), Kana Yamada (a1), Chie Kurokawa (a1), Hiroaki Kunogi (a1), Yoshiro Sakamoto (a2) and Keisuke Sasai (a3)...

Abstract

Aim

Late adverse effects following radiation therapy for prostate cancer involve the urinary and lower gastrointestinal tracts, with continuous rectal bleeding being the most serious issue. We focused on late adverse effects, particularly rectal bleeding after volumetric-modulated arc therapy (VMAT), for patients with locally advanced prostate cancer.

Materials and Methods

Seventy-three patients with localized prostate cancer were treated with radiation therapy using VMAT with an image-guided radiation therapy system. Patient age at the start of irradiation ranged from 54 to 81 years (median, 71 years). The follow-up period ranged from 23 to 87 months (median, 57 months). The prescribed total irradiation dose was 76 Gy in 38 fractions.

Results

Late rectal bleeding was observed in 14 (19%) patients, with nine (12.3%), four (5.5%), and one (1.4%) being classified as grades 1, 2, and 3, respectively. One grade 3 patient with rectal bleeding had severe diabetes and was administered intravenous warfarin for cardiomyopathy.

Findings

VMAT may provide better accuracy and involve fewer time constraints for patients compared with other intensity-modulated radiation therapy (IMRT) methods. The incidence of late rectal bleeding in VMAT is almost equivalent to that of other IMRT methods.

Copyright

Corresponding author

Author for correspondence: Yutaka Naoi, Department of Radiation Oncology, Juntendo University Nerima Hospital, 3-1-10 Takanodai Nerima-ku, Tokyo 177-8521, Japan. Tel: 813-5923-3111. Fax: 813-5923-3237. E-mail: naoi@alpha.ocn.ne.jp

Footnotes

Hide All

Cite this article: Naoi Y, Yamada K, Kurokawa C, Kunogi H, Sakamoto Y, Sasai K. (2019) Late rectal bleeding after volumetric-modulated arc therapy for localised prostatic cancer. Journal of Radiotherapy in Practice18: 165–168. doi: 10.1017/S1460396918000560

Footnotes

References

Hide All
1. Wolff, D, Stieler, F, Welzel, G et al. Volumetric modulated arc therapy (VMAT) vs. serial tomotherapy, step-and-shoot IMRT and 3D-conformal RT for treatment of prostate cancer. Radiother Oncol 2009; 93: 226233.
2. Tsutsumi, S, Hosono, M. N, Tatsumi, D et al. Delivery parameter variations and early clinical outcomes of volumetric modulated arc therapy for 31 prostate cancer patients: an intercomparison of three treatment planning systems. Scient World J 2013; Article ID 289809, 7. DOI: 10.1155/2013/289809.10.1155/2013/289809
3. Tambas, M, Agaoglu, F, Iribas, A et al. Conventionally fractionationed volumetric arc therapy versus hypofractionated stereotactic body radiotherapy: quality of life, side effects, and prostate-specific antigen kinetics in localized prostate cancer. 3. Value Health Reg Issues 2016; 10: 9199 DOI: 10.1016/j.vhri.2016.08.001. Epub 2016 Oct 6.
4. Palma, D, Vollans, E, James, K et al. Volumetric modulated arc therapy for delivery of prostate radiotherapy: comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72: 9961001 DOI: 10.1016/j.ijrobp.2008.02.047. Epub 2008 May.10.1016/j.ijrobp.2008.02.047
5. Takemoto, S, Shibamoto, Y, Ayakawa, S et al. Treatment and prognosis of patients with late rectal bleeding after intensity-modulated radiation therapy for prostate cancer. Radiat Oncol 2012; 7: 87.10.1186/1748-717X-7-87
6. Budaus, L, Bolla, M, Bossi, A et al. Functional outcomes and complications following radiation therapy for prostate cancer: a critical analysis of the literature. Eur . Urol 2012; 61: 112127.
7. Michalski, J. RTOG 0126 (10/18/04) A phase III randomized study of high dose 3DCRT/IMRT versus standard dose 3DCRT/IMRT in patients treated for localized prostate cancer. https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0126. Accessed on 3rd April 2009.
8. Stokkevåg, C. H, Engeseth, G. M, Hysing, L. B, Ytre-Hauge, K. S, Ekanger, C, Muren, L. P. Risk of radiation-induced secondary rectal and bladder cancer following radiotherapy of prostate cancer. Acta Oncol 2015; 54: 13171325 DOI: 10.3109/0284186X.2015.1061691.
9. Zelefsky, M. J, Fuks, Z, Hunt, M et al. High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys 2002; 53: 11111116.
10. Vora, S. A, Wong, W. W, Schild, S. E, Ezzell, G. A, Halyard, M. Y. Analysis of biochemical control and prognostic factors in patients treated with either low-dose three-dimensional conformal radiation therapy or high-dose intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2007; 68: 10531058 DOI: 10.1016/j.ijrobp.2007.01.043.
11. Zapatero, A, Guerrero, A, Maldonado, X et al. High-dose radiotherapy with short-term or long-term androgen deprivation in localised prostate cancer (DART01/05 GICOR): a randomised, controlled. Lancet Oncol 2015; 16: 320327.10.1016/S1470-2045(15)70045-8
12. Wortel, R. C, Incrocci, L, Pos, F. J et al. Late side effects after image guided intensity modulated radiation therapy compared to 3D-conformal radiation therapy for prostate cancer: results from 2 prospective cohorts. Int J Radiat Oncol Biol Phys 2016; 95: 681689.
13. Okonogi, N, Katoh, H, Kawamura, H et al. Clinical outcomes of helical tomotherapy for super-elderly patients with localized and locally advanced prostate cancer: comparison with patients under 80 years of age. J Radiat Res 2015; 15: 889896 doi: DOI: 10.1093/jrr/rrv040.
14. Mizowaki, T, Norihisa, Y, Takayama, K et al. Long-term outcomes of intensity-modulated radiation therapy combined with neoadjuvant androgen deprivation therapy under an early salvage policy for patients with T3-T4N0M0 prostate cancer. Int J Clin Oncol 2016; 28: 148155 DOI: 10.1007/s10147-015-0867-7.10.1007/s10147-015-0867-7
15. Dearnaley, D, Syndikus, I, Mossop, H et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol 2016; 17: 10471060 DOI: 10.1016/S1470-2045(16)30102-4.
16. Katahira-Suzuki, R, Omura, M, Takano, S et al. Clinical and dosimetric predictors of late rectal bleeding of prostate cancer after TomoTherapy intensity modulated radiation therapy. J Med Radiat Sci 2017; 64: 172179.
17. Someya, M, Hori, M, Tateoka, K et al. Results and DVH analysis of late rectal bleeding in patients treated with 3D-CRT or IMRT for localized prostate cancer. J Radiat Res 2015; 56: 122127.
18. Wolff, D, Stieler, F, Welzel, G et al. Volumetric modulated arc therapy (VMAT) vs. serial tomotherapy, step-and-shoot IMRT and 3D-conformal RT for treatment of prostate cancer. Radiother Oncol 2009; 93: 226233 DOI: 10.1016/j.radonc.2009.08.011.
19. Inokuchi, H, Mizowaki, T, Norihisa, Y et al. Clinical effect of multileaf collimator width on the incidence of late rectal bleeding after high‑dose intensity‑modulated radiotherapy for localized prostate carcinoma. Int J Clin Oncol 2016; 21: 156161 DOI: 10.1007/s10147-015-0873-9.
20. Groh, B. A, Siewerdsen, J. H, Drake, D. G, Wong, J. W, Jaffray, D. A. A performance comparison of flat-panel imager-based MV and kV cone-beam. CT Med Phys 2002; 29: 967975.
21. Elith, C, Dempsey, S. E, Findlay, N, Warren-Forward, H. M. An introduction to the intensity-modulated radiation therapy(IMRT) techniques, tomotherapy, and VMAT. J Med Imag Radiat Sci 2011; 42: 3743 DOI: 10.1016/j.jmir.2010.11.005.
22. Rao, M, Yang, W, Chen, F et al. Comparison of Elekta VMAT with helical tomotherapy and fixed field IMRT: plan quality, delivery efficiency and accuracy. Med Phys 2010; 37: 13501359.
23. Tanaka, H, Yamaguchi, T, Hachiya, K et al. Treatment outcomes and late toxicities of intensity-modulated radiation therapy for 1091 Japanese patients with localized prostate cancer. Rep Pract Oncol Radiother 2018; 23: 2833 DOI: 10.1016/j.rpor.2017.11.002.10.1016/j.rpor.2017.11.002
24. Zelefsky, M. J, Kollmeier, M, Cox, B et al. Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2012; 84: 125129 DOI: 10.1016/j.ijrobp.2011.11.047.10.1016/j.ijrobp.2011.11.047

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed