title: A review of rectal toxicity following permanent low dose-rate prostate brachytherapy and the potential value of biodegradable rectal spacers.
abstract: Permanent radioactive seed implantation provides highly effective treatment for prostate cancer that typically includes multidisciplinary collaboration between urologists and radiation oncologists. Low dose-rate (LDR) prostate brachytherapy offers excellent tumor control rates and has equivalent rates of rectal toxicity when compared with external beam radiotherapy. Owing to its proximity to the anterior rectal wall, a small portion of the rectum is often exposed to high doses of ionizing radiation from this procedure. Although rare, some patients develop transfusion-dependent rectal bleeding, ulcers or fistulas. These complications occasionally require permanent colostomy and thus can significantly impact a patient's quality of life. Aside from proper technique, a promising strategy has emerged that can help avoid these complications. By injecting biodegradable materials behind Denonviller's fascia, brachytherpists can increase the distance between the rectum and the radioactive sources to significantly decrease the rectal dose. This review summarizes the progress in this area and its applicability for use in combination with permanent LDR brachytherapy.
authors: Department of Radiation Oncology, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA.
authors: M E
authors: ME
authors: Schutzer
authors: Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors: P F
authors: PF
authors: Orio
authors: Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA.
authors: M C
authors: MC
authors: Biagioli
authors: Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: D A
authors: DA
authors: Asher
authors: Department of Radiation Oncology, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA.
authors: H
authors: H
authors: Lomas
authors: 1] Department of Radiation Oncology, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA [2] Department of Radiation Oncology Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA.
authors: D
authors: D
authors: Moghanaki
mesh_terms: D020341:Absorbable Implants; D001918:Brachytherapy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011467:Prostate / Q000473:pathology / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011839:Radiation, Ionizing; D012007:Rectum / Q000473:pathology / Q000528:radiation effects; D016896:Treatment Outcome