title: Acute urinary toxicity following transperineal prostate brachytherapy using a modified Quimby loading method.
abstract: OBJECTIVE
  To examine the acute urinary toxicity following transperineal prostate implant using a modified Quimby loading method with regard to time course, severity, and factors that may be associated with a higher incidence of morbidity.
  
  
  METHODS
  One hundred thirty-nine patients with prostate adenocarcinoma treated with brachytherapy from 1997 through 1999 had follow-up records available for review. Patients considered for definitive brachytherapy alone included those with prostate specific antigen (PSA) < or = 6, Gleason score (GS) < or = 6, clinical stage < T2b, and prostate volumes generally less than 40 cc. Patients with larger prostate volumes were given neoadjuvant antiandrogen therapy. Those with GS > 6, PSA > 6, or Stage > T2a were treated with external beam radiation therapy followed by brachytherapy boost. Sources were loaded according to a modified Quimby method. At each follow-up, toxicity was graded based on a modified RTOG urinary toxicity scale.
  
  
  RESULTS
  Acute urinary toxicity occurred in 88%. Grade I toxicity was reported in 23%, grade II in 45%, and grade III in 20%, with 14% requiring prolonged (greater than 1 week) intermittent or indwelling catheterization. Overall median duration of symptoms was 12 months. There was no difference in duration of symptoms between patients treated with I-125 or Pd-103 sources (p = 0.71). After adjusting for GS and PSA, multivariate logistic regression analysis showed higher incidence of grade 3 toxicity in patients with larger prostate volumes (p = 0.002), and those with more seeds implanted (p < 0.001). Higher incidence of prolonged catheterization was found in patients receiving brachytherapy alone (p = 0.01), with larger prostate volumes (p = 0.01), and those with more seeds implanted (p < 0.001).
  
  
  CONCLUSIONS
  Interstitial brachytherapy for prostate cancer leads to a high incidence of acute urinary toxicity, most of which is mild to moderate in severity. A prolonged need for catheterization can occur in some patients. Patients receiving brachytherapy alone, those with prostate volumes greater than 30 cc, and those implanted with a greater number of seeds have the highest incidence of significant toxicity.
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA. kang@radonc.duke.edu
authors: S K
authors: SK
authors: Kang
authors: R H
authors: RH
authors: Chou
authors: R K
authors: RK
authors: Dodge
authors: R W
authors: RW
authors: Clough
authors: H L
authors: HL
authors: Kang
authors: M G
authors: MG
authors: Bowen
authors: B A
authors: BA
authors: Steffey
authors: S K
authors: SK
authors: Das
authors: S M
authors: SM
authors: Zhou
authors: A W
authors: AW
authors: Whitehurst
authors: N J
authors: NJ
authors: Buckley
authors: J H
authors: JH
authors: Kim
authors: R E
authors: RE
authors: Joyner
authors: I
authors: I
authors: Sarmina
authors: G S
authors: GS
authors: Montana
authors: S S
authors: SS
authors: Ingram
authors: M S
authors: MS
authors: Anscher
mesh_terms: D000208:Acute Disease; D000230:Adenocarcinoma / Q000097:blood / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010165:Palladium / Q000627:therapeutic use; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use; D014555:Urination Disorders / Q000209:etiology*
chemical_list: D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium; D017430:Prostate-Specific Antigen