ArticleActa oncologica (Stockholm, Sweden)2025
Risk factors for rectal bleeding in prostate cancer after radiotherapy with a validation of current rectal dose constraints.
Article in Acta oncologica (Stockholm, Sweden), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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8 authors.
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Abstract
backgroundRectal bleeding is a well-known adverse event following pelvic external beam radiotherapy (EBRT) for prostate cancer. This study investigates risk factors for rectal bleeding and validate our current rectal dose constraints in a real-world setting. MATERIAL AND
methodsThis prospective study includes 248 prostate cancer patients who received EBRT between 2017-2022. EBRT consisted of 56 Gy/39 fractions to the prostate, elective lymph nodes, and seminal vesicles with an integrated boost of 78 Gy to the prostate alone (≤T3a) or to the prostate and seminal vesicles (T3b). Rectal dose constraints were V50 Gy ≤50%, V70 Gy ≤20%, and V74 Gy ≤12%. Rectal bleeding was recorded at baseline and regularly duringfollow-up and included staff reported morbidity and patient reported outcome measures. Risk factors were evaluated in multivariate cox regression analysis.
resultsMedian follow-up was 18 months (range 1-61 months). Sixteen percent (CI:11%;22%) of patients reported rectal bleeding as "rarely", 4%(CI:2%;8%) "about half the time", 0% "usually", and 2%(CI:0%;4%) "always". Five percent reported rectal bleeding as bothersome. It was possible to comply with current rectal dose constraint (V74 Gy ≤12%) in 99.6% of all patients. Body mass index (BMI) (BMI:25-29.9, HR:0.54(CI:0.30;0.98), p=.044 or BMI>29.9, HR:0.40(CI:0.20;0.79), p=0.008)) were predictors for rectal bleeding.
interpretationPatient-reported rectal bleeding is common after prostate cancer radiotherapy. High BMI was a protective factor against rectal bleeding. No correlation was observed between rectal dose-volume constraints and the occurrence of rectal bleeding, suggesting that a rectal high-dose constraint of V74 Gy ≤12% is an adequate threshold to minimize patient-reported rectal bleeding.
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