Rectal bleeding after hypofractionated radiotherapy for prostate cancer: correlation between clinical and dosimetric parameters and the incidence of grade 2 or worse rectal bleeding.
OBJECTIVE
To investigate the incidence and severity of rectal bleeding after high-dose hypofractionated radiotherapy (RT) for prostate cancer, and to explore the factors affecting the incidence of Grade 2 or worse rectal bleeding.


METHODS
The data of 52 patients who had been treated by external beam RT for localized prostate cancer between 1999 and 2002 were analyzed. All the patients had received hypofractionated external beam RT to a total dose of 69 Gy in 3-Gy fractions, three fractions weekly. The clinical and dosimetric factors affecting the incidence of Grade 2 or worse late rectal bleeding were analyzed by univariate and multivariate analyses. The effect of the percentage of the whole rectal volume receiving 30%, 50%, 80%, and 90% of the prescribed radiation dose (V(30), V(50), V(80), and V(90), respectively) on the incidence of rectal bleeding was evaluated.


RESULTS
Of the 52 patients, 13 (25%) developed Grade 2 or worse rectal bleeding. One patient who needed laser coagulation and blood transfusion for the treatment of rectal bleeding was classified as having Grade 3 rectal bleeding. The median time to the development of Grade 2 or worse rectal bleeding was 11 months. The results of the univariate analysis revealed that the presence of a history of diabetes mellitus (p < 0.001), and V(30) >/= 60%, V(50) >/= 40% (p < 0.05), V(80) >/= 25%, and V(90) >/= 15% (p < 0.001) were statistically significant risk factors for the occurrence of Grade 2 or worse rectal bleeding. The results of the multivariate analysis revealed that a history of diabetes mellitus was the most statistically significant risk factor for the occurrence of rectal bleeding after hypofractionated RT for prostate cancer (p < 0.05).


CONCLUSIONS
A history of diabetes mellitus was the most statistically significant risk factor for the occurrence of Grade 2 or worse rectal bleeding after high-dose hypofractionated RT, although dosimetric factors were also closely associated with the risk of rectal bleeding.
Akimoto
Tetsuo
T
Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. takimoto@showa.gunma-u.ac.jp
Muramatsu
Hiroyuki
H
Takahashi
Mitsuhiro
M
Saito
Jun-Ichi
J
Kitamoto
Yoshizumi
Y
Harashima
Koichi
K
Miyazawa
Yasushi
Y
Yamada
Masami
M
Ito
Kazuto
K
Kurokawa
Kouhei
K
Yamanaka
Hidetoshi
H
Nakano
Takashi
T
Mitsuhashi
Norio
N
Niibe
Hideo
H
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D048909:Diabetes Complications; D019583:Dose Fractionation, Radiation; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D012002:Rectal Diseases / Q000453:epidemiology / Q000209:etiology*; D012007:Rectum / Q000528:radiation effects*; D012307:Risk Factors