title: Comparison of acute and subacute genitourinary and gastrointestinal adverse events of radiotherapy for prostate cancer using intensity-modulated radiation therapy, three-dimensional conformal radiation therapy, permanent implant brachytherapy and high-dose-rate brachytherapy.
abstract: OBJECTIVE
  To examine acute and subacute urinary and rectal toxicity in patients with localized prostate cancer monotherapeutically treated with the following four radiotherapeutic techniques: intensity-modulated radiation therapy, three-dimensional conformal radiation therapy, low-dose-rate permanent implant brachytherapy using I-125 seeds, and high-dose-rate brachytherapy.
  
  
  METHODS
  One hundred and fifty-six patients with localized prostate cancer were distributed as follows: 57 underwent intensity-modulated radiation therapy, 35 underwent three-dimensional conformal radiation therapy, 37 underwent I-125 implant, and 27 underwent high-dose-rate brachytherapy. The prescribed doses were 70-74 Gy/35-37 fractions, 70 Gy/35 fractions, 145 Gy, and 45.5 Gy/7 fraction/4 days for intensity-modulated radiation therapy, three-dimensional conformal radiation therapy, I-125 implant, and high-dose-rate brachytherapy, respectively. Toxicities (≤6 months) were retrospectively evaluated using the Common Terminology Criteria for Adverse Events version 4.03.
  
  
  RESULTS
  The frequency of grade 1 or 2 urinary toxicities using three-dimensional conformal radiation therapy (33/35, 94%) was significantly higher than that with high-dose-rate brachytherapy (18/27, 67%) or intensity-modulated radiation therapy (37/57, 65%) (P <0.05). The frequency of grade 1 or 2 urinary toxicities using I-125 implant was 31/37, 84%. The frequency of grade 1 or 2 gastrointestinal toxicities using three-dimensional conformal radiation therapy (17/35, 49%) was significantly higher than that using I-125 implant (4/37, 11%) or high-dose-rate brachytherapy (0/27, 0%) (P <0.05). Using intensity-modulated radiation therapy, the frequency of grade 1 or 2 gastrointestinal toxicities was 18/57 (32%), which was significantly higher than that using high-dose-rate brachytherapy (0/27, 0%) (P <0.05). Grade 3 or greater adverse events were not observed.
  
  
  CONCLUSIONS
  Acute and subacute genitourinary toxicities were observed more frequently after three-dimensional conformal radiation therapy than after high-dose-rate brachytherapy or intensity-modulated radiation therapy. Acute and subacute gastrointestinal toxicities were seen more often after three-dimensional conformal radiation therapy than after brachytherapy (I-125 implant or high-dose-rate brachytherapy).
authors: Masahiro
authors: M
authors: Morimoto
authors: Yasuo
authors: Y
authors: Yoshioka
authors: Koji
authors: K
authors: Konishi
authors: Fumiaki
authors: F
authors: Isohashi
authors: Yutaka
authors: Y
authors: Takahashi
authors: Toshiyuki
authors: T
authors: Ogata
authors: Masahiko
authors: M
authors: Koizumi
authors: Teruki
authors: T
authors: Teshima
authors: Henk P
authors: HP
authors: Bijl
authors: Arjen
authors: A
authors: van der Schaaf
authors: Johannes A
authors: JA
authors: Langendijk
authors: Kazuhiko
authors: K
authors: Ogawa
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods*; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006801:Humans; D021621:Imaging, Three-Dimensional; D007457:Iodine Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012007:Rectum / Q000528:radiation effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D014555:Urination Disorders / Q000209:etiology*; D014566:Urogenital System / Q000528:radiation effects
chemical_list: D007457:Iodine Radioisotopes