title: Rectal Ulcers and Rectoprostatic Fistulas after (125)I Low Dose Rate Prostate Brachytherapy.
abstract: Radiation induced rectal ulcers and fistulas are rare but significant complications of low dose rate prostate brachytherapy for localized prostate cancer. We describe the incidence of ulcers and fistulas, and associated risk factors.
  
  
  
  We reviewed the records of 4,690 patients with localized prostate cancer who were treated with low dose rate (125)I prostate brachytherapy to a dose of 144 Gy with or without 6 months of androgen deprivation therapy. Patient, disease, comorbidity, treatment, dosimetric and posttreatment intervention factors were analyzed for an association with ulcer or fistula formation.
  
  
  
  At a median followup of 53 months 21 cases were identified, including 15 rectal ulcer cases, of which 6 progressed to fistulas, and an additional 6 cases of fistulas with no prior documented ulcers. Overall 9 rectal ulcer cases (0.19%) and 12 fistula cases (0.26%) were identified. In 8 of 15 patients ulcers healed with conservative management. No fistulas healed without surgical management. Two patients with fistulas died. Eight patients diagnosed with rectal ulcers subsequently underwent rectal biopsies, after which fistulas developed in 3. One patient with a de novo fistula underwent a preceding biopsy. Urinary interventions such as transurethral resection of the prostate were performed after brachytherapy in 5 of 12 patients with fistulas compared to 0 of 9 with ulcers alone. Argon plasma coagulation of the rectum for hematochezia was performed after brachytherapy in 3 of 12 patients with fistulas.
  
  
  
  Rates of post-brachytherapy rectal ulcers and fistulas are low as previously described. Post-brachytherapy interventions such as rectal biopsy, argon coagulation and urinary intervention may increase the risk of fistulas.
authors.affiliation: British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, Canada.
authors.forename: Nelson
authors.initials: N
authors.lastname: Leong
authors.affiliation: British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, Canada; Department of Radiotherapy and Developmental Radiotherapeutics, University of British Columbia, British Columbia, Canada. Electronic address: hpai@bccancer.bc.ca.
authors.forename: Howard H
authors.initials: HH
authors.lastname: Pai
authors.affiliation: British Columbia Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada; Department of Radiotherapy and Developmental Radiotherapeutics, University of British Columbia, British Columbia, Canada.
authors.forename: W James
authors.initials: WJ
authors.lastname: Morris
authors.affiliation: British Columbia Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada; Department of Radiotherapy and Developmental Radiotherapeutics, University of British Columbia, British Columbia, Canada.
authors.forename: Mira
authors.initials: M
authors.lastname: Keyes
authors.affiliation: British Columbia Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada; Department of Radiotherapy and Developmental Radiotherapeutics, University of British Columbia, British Columbia, Canada.
authors.forename: Tom
authors.initials: T
authors.lastname: Pickles
authors.affiliation: British Columbia Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada; Department of Radiotherapy and Developmental Radiotherapeutics, University of British Columbia, British Columbia, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
authors.affiliation: British Columbia Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada; Department of Radiotherapy and Developmental Radiotherapeutics, University of British Columbia, British Columbia, Canada.
authors.forename: Jonn
authors.initials: J
authors.lastname: Wu
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000453:epidemiology; D012003:Rectal Fistula / Q000150:complications* / Q000453:epidemiology; D012007:Rectum / Q000473:pathology*; D012307:Risk Factors; D014456:Ulcer / Q000150:complications* / Q000453:epidemiology
keywords: brachytherapy; fistula; iatrogenic disease; prostatic neoplasms; ulcer