title: Patient-reported complications from fiducial marker implantation for prostate image-guided radiotherapy.
abstract: OBJECTIVE
  To report on complications from transrectal ultrasound-guided insertion of fiducial markers for prostate image-guided radiotherapy.
  
  
  METHODS
  234 patients who underwent transrectal fiducial marker insertion for prostate cancer image-guided radiotherapy were assessed retrospectively by questionnaire with regard to the duration and severity of eight symptoms experienced following the procedure. Pain during the implantation procedure was assessed according to the Wong-Baker faces pain scale.
  
  
  RESULTS
  Of 234 patients, 32% had at least one new symptom after the procedure. The commonest new symptom following the procedure was urinary frequency affecting 16% of patients who had not been troubled by frequency beforehand. Haematuria, rectal bleeding, dysuria and haematospermia affected 9-13% of patients, mostly at Grade 1 or 2. Pain, obstruction, and fever and shivers affected 3-4% of patients. Grade 3 rectal bleeding, haematuria, fever and shivers, and urinary frequency affected 0.5-1.5% of patients. Only one patient had a Grade 4 complication (i.e. fever and shivers). Overall, 9% of patients had symptoms lasting more than 2 weeks. The commonest symptoms that lasted more than 2 weeks were frequency, dysuria, obstructive symptoms and rectal bleeding. Mean pain score during the procedure was 1.1 (range 0-5).
  
  
  CONCLUSIONS
  Transrectal ultrasound-guided fiducial marker insertion for image-guided radiotherapy is well tolerated in the majority of prostate cancer patients. Most symptoms were Grade 1 or 2 in severity. Symptoms in the majority of patients last under 2 weeks. The most serious complication was sepsis in our study.
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. suki.gill@petermac.org
authors.forename: S
authors.initials: S
authors.lastname: Gill
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: J
authors.initials: J
authors.lastname: Thomas
authors.forename: M
authors.initials: M
authors.lastname: Bressel
authors.forename: K
authors.initials: K
authors.lastname: Thursky
authors.forename: C
authors.initials: C
authors.lastname: Styles
authors.forename: K H
authors.initials: KH
authors.lastname: Tai
authors.forename: G M
authors.initials: GM
authors.lastname: Duchesne
authors.forename: F
authors.initials: F
authors.lastname: Foroudi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005334:Fever / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D057918:Fiducial Markers / Q000009:adverse effects*; D005500:Follow-Up Studies; D006417:Hematuria / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D018084:Ultrasonography, Interventional / Q000379:methods; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology