The effect of constipation on rectal dosimetry following prostate brachytherapy

The purpose of this study is to report the effect of dilatation of the anorectum on rectal dosimetry following an 125I prostate implant. Three months following prostate brachytherapy, 2 computed tomography (CT) scans of the prostate gland were obtained within 90 minutes of each other. The first CT scan revealed a dilated anorectum secondary to constipation. The second CT was obtained following the administration of an enema with a successfully evacuated rectum. Differences in radiation doses to the distended and empty rectum were computed via the mean dose, the maximum dose per slice, the distance from the base, and in terms of the surface of the anterior quadrant of the rectum receiving 100%, 125%, 150%, 175%, 200%, and 250% of the prescribed dose. The dose to the rectal wall was substantially increased in the distended state for all evaluated parameters. In general, the mean dose to the rectal wall was increased by a factor of 1.5 in the distended state. In both scenarios, the dose to the rectal wall peaked near midgland. In terms of 10 degrees rectal wall sectors receiving a given percentage of the prescribed minimal peripheral dose, S%mPD, the S100, S125, S150, S175, S200, and S250 were substantially greater for the distended versus the empty rectum. The magnitude of the percentage difference in dose between the distended and evacuated rectum increased with dose level while the difference in the number of sectors receiving a given dose level was greatest at 125% and 150% of the prescribed dose. We recommend detailed postimplant attention to bowel habits for at least 2 half-lives of the implanted isotope to minimize rectal distention, decrease radiation dose to the anterior rectal wall, and subsequently minimize potential constipation related rectal toxicity.