Risk factors for rectal bleeding in prostate cancer after radiotherapy with a validation of current rectal dose constraints
Background: Rectal 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 methods: This prospective...
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| Format: | Article |
| Language: | English |
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Medical Journals Sweden
2025-05-01
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| Series: | Acta Oncologica |
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| Online Access: | https://medicaljournalssweden.se/actaoncologica/article/view/42551 |
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| author | Ellen Lund Schaldemose Christine Vestergaard Madsen Ahmed Hussein Zedan Martin Berg Henrik Dahl Nissen Terje Andersen Bjarke Mortensen Lars Ulrik Fokdal |
| author_facet | Ellen Lund Schaldemose Christine Vestergaard Madsen Ahmed Hussein Zedan Martin Berg Henrik Dahl Nissen Terje Andersen Bjarke Mortensen Lars Ulrik Fokdal |
| author_sort | Ellen Lund Schaldemose |
| collection | DOAJ |
| description | Background: Rectal 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 methods: This 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.
Results: Median 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.
Interpretation: Patient-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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| format | Article |
| id | doaj-art-ec1a1cc0cc35441f95fc13d97f6572c8 |
| institution | DOAJ |
| issn | 1651-226X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Oncologica |
| spelling | doaj-art-ec1a1cc0cc35441f95fc13d97f6572c82025-08-20T02:57:55ZengMedical Journals SwedenActa Oncologica1651-226X2025-05-016410.2340/1651-226X.2025.42551Risk factors for rectal bleeding in prostate cancer after radiotherapy with a validation of current rectal dose constraintsEllen Lund Schaldemose0https://orcid.org/0000-0002-0994-648XChristine Vestergaard Madsen1https://orcid.org/0000-0002-8314-3888Ahmed Hussein Zedan2https://orcid.org/0000-0002-8895-6394Martin Berg3https://orcid.org/0000-0001-6943-3267Henrik Dahl Nissen4https://orcid.org/0000-0002-5002-5463Terje Andersen5Bjarke Mortensen 6https://orcid.org/0009-0002-8889-2797Lars Ulrik Fokdal7https://orcid.org/0000-0003-4382-4694Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, DenmarkDepartment of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, DenmarkDepartment of Oncology, Vejle HospitalRadiotherapy Research Team, Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, DenmarkRadiotherapy Research Team, Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, DenmarkRadiotherapy Research Team, Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, DenmarkRadiotherapy Research Team, Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, DenmarkDepartment of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, DenmarkBackground: Rectal 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 methods: This 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. Results: Median 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. Interpretation: Patient-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. https://medicaljournalssweden.se/actaoncologica/article/view/42551rectal bleedingcurative radiotherapyprostate cancer |
| spellingShingle | Ellen Lund Schaldemose Christine Vestergaard Madsen Ahmed Hussein Zedan Martin Berg Henrik Dahl Nissen Terje Andersen Bjarke Mortensen Lars Ulrik Fokdal Risk factors for rectal bleeding in prostate cancer after radiotherapy with a validation of current rectal dose constraints Acta Oncologica rectal bleeding curative radiotherapy prostate cancer |
| title | Risk factors for rectal bleeding in prostate cancer after radiotherapy with a validation of current rectal dose constraints |
| title_full | Risk factors for rectal bleeding in prostate cancer after radiotherapy with a validation of current rectal dose constraints |
| title_fullStr | Risk factors for rectal bleeding in prostate cancer after radiotherapy with a validation of current rectal dose constraints |
| title_full_unstemmed | Risk factors for rectal bleeding in prostate cancer after radiotherapy with a validation of current rectal dose constraints |
| title_short | Risk factors for rectal bleeding in prostate cancer after radiotherapy with a validation of current rectal dose constraints |
| title_sort | risk factors for rectal bleeding in prostate cancer after radiotherapy with a validation of current rectal dose constraints |
| topic | rectal bleeding curative radiotherapy prostate cancer |
| url | https://medicaljournalssweden.se/actaoncologica/article/view/42551 |
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