Incidence and clinical course of hemorrhagic radiation proctitis after iodine-125 prostate brachytherapy

PURPOSE: Hemorrhagic radiation proctitis (HRP) is a potential complication of prostate brachytherapy. We sought to determine the incidence and clinical course of hemorrhagic radiation proctitis after iodine-125 (125I) prostate brachytherapy. PATIENTS AND METHODS: Between 1995 and 2003, 221 consecutive patients were treated at the Barrett Cancer Center with permanent 125I seed implantation for presumed localized adenocarcinoma of the prostate. No patients received EBRT. All cases of HRP were confirmed by colonoscopy. Median follow-up was 52 months. All patients were evaluated for HRP using a 5-grade rectal bleeding scale developed by the Radiation Therapeutic Oncology Group. RESULTS: Thirty-three patients experienced grade>or=1 toxicity at some point after treatment. Twenty patients developed grade 2 toxicity, 9 developed grade 3, and 2 developed grade 4. The median time to onset of symptoms of HRP was 14 months. The incidence of HRP had a bimodal temporal onset, with a peak seen at 4 months and a second larger peak at 16 months. Peak toxicity occurred at 18 months after the onset of rectal bleeding, after which there was a sharp decline in toxicity. CONCLUSION: This study demonstrates tolerable rectal morbidity after transperineal prostate brachytherapy of the prostate. Hemorrhagic radiation proctitis occurring after brachytherapy for prostate cancer is usually self-limiting and frequently resolves without treatment or with minor medical treatment. Patients develop HRP soon after treatment or after a delay in treatment. Symptoms appear to peak 18 months after the onset of HRP.