International Journal of Radiation Oncology*Biology*Physics
Clinical investigationProstateQuality of life of patients after permanent prostate brachytherapy in relation to dosimetry
Introduction
Localized prostate cancer can be treated with prostatectomy, external beam radiotherapy, and brachytherapy (1, 2, 3, 4, 5). With all techniques, a comparable tumor control is achievable, but differences are found in the treatment-related problems and the quality of life (QoL) of the patients during treatment (3, 6, 7, 8, 9). The American Brachytherapy Society has published guidelines for the reporting of treatment-related morbidity after prostate brachytherapy (10). The relationship between toxicity and the dose distribution after permanent prostate brachytherapy has been investigated in many studies (11, 12, 13, 14, 15, 16). Mostly, the toxicity is determined according to the Radiation Therapy Oncology Group (RTOG) scales or the Common Toxicity Criteria (17, 18). Different studies resulted in opposite predictors because of different patient groups (11, 15, 16). Beside the evaluations of toxicity by the physician, QoL reflects the patient’s perspective. Litwin et al. (19) showed that physicians underscored problems after treatment compared with results of self-administered patient questionnaires.
Studies investigating the relationship between postimplant dose calculations and QoL measured by questionnaires are scarce. Merrick et al. (20, 21) found that tobacco consumption was the strongest predictor of late urinary problems, and no predictor was found to predict changes in bowel function. Locke et al. (22) investigated factors for the risk of retention and the duration of retention. They found that the only predicting factor was postimplant prostate volume. The dose distributions in these studies were based on CT. Inaccuracies in the dose distribution were caused by swelling of the prostate due to the insertion of the needles (23, 24) and inter- and intraobserver variabilities in delineation of the organs (25, 26, 27, 28). The variabilities in contouring become smaller when the quality of the images improves. To distinguish the prostate and rectum wall or the prostate and bladder, MR images are more useful than CT (29, 30, 31).
The goal of this study was to investigate changes in QoL, scored with a combination of self-administered questionnaires, after a permanent prostate brachytherapy implant and to correlate these changes with postimplant dosimetry based on MR images.
Section snippets
Patients
This study is an analysis of patients with low-stage prostate cancer (Stage T1 or T2) and treated with brachytherapy at the Department of Radiotherapy, University Medical Center Utrecht (Utrecht, The Netherlands) between December 2000 and June 2003. In this period, we collected data for 127 patients.
Implantation and evaluation method
During the implantation of radioactive I-125 seeds, an intraoperative plan was made with the system for Sonographic Planning for Oncology Treatment (SPOT; Nucletron, Veenendaal, The Netherlands).
Dosimetry
The mean and standard deviation of the dosimetry and implant-specific parameters are presented in Table 1. We used two techniques for insertion of the iodine seeds: manual insertion of RAPID Strands (type 6711; Amersham, Eindhoven, The Netherlands) and automatic delivery of selectSeeds with the seedSelectron (Nucletron). Comparable dosimetric results were achieved with both techniques (41).
The urethra was visible on MR images of 44 patients.
For the regression analysis, a set of independent
Discussion
Brachytherapy is a common treatment method for prostate cancer. It is important to make a seeds configuration such that the prostate is irradiated with the prescribed dose while the dose to the critical organs is minimized. Postplanning is necessary to determine the actual dose delivered to the prostate and surrounding tissues. In this study, we correlated postimplant dosimetry data with QoL data. Patients answered a QoL questionnaire at five times (one before and four after treatment) to
Acknowledgments
We thank Paul Westers from the Center of Biostatistics, Utrecht, for his assistance with statistical analysis.
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