Biomedical subjects

K Wallner

Publications and source records attributed to K Wallner.

At least 37 records · Page 2Linked to original sources

PubMed2000

Treatment margins for prostate brachytherapy.

The purpose of this article was to determine what planned treatment margin (TM) would allow for implant-related prostate volume changes and still achieve an adequate periprostatic cancercidal dose. Twenty consecutive, unselected patients who underwent (125)I implantation (144 Gy prescription dose) were studied. The treated volume (TV) was calculated as the volume encompassed by the 144 Gy isodose distribution. A post-implant computed tomography scan was obtained the following day, using 5-mm images at every 5 mm. The distances between the prostate margin (GTV) and TV were determined by measuring the distance between the ultrasound-defined prostatic margin and the prescription isodose, perpendicular to the prostatic margin. The lateral, anterior, and posterior TM margins were determined at the base, mid-level, and apex of the prostate. The pre-implant TV was nearly twice as large as the GTV, ranging from 36 to 199 mL (median, 73 mL). The anterior, lateral, and posterior planned TMs varied substantially between patients, due to lack of a consistent policy the magnitude of the CTV and the acceptable CTV-to-TV distance. For all measurement points, the median planned treatment margin was 3 mm (range, -16 mm to 14 mm). Overall, there was only a loose correlation between pre- and post-implant treatment margins primarily due to variable, implant-related prostatic dimensional changes. Patients with a greater implant-related volume increase tended to have smaller post-implant treatment margins. The post-implant TMs were negatively correlated with dimensional changes, and the negative correlation was most marked for the anterior and posterior TMs due to predominant anterior-posterior dimensional increase. As expected, the post-implant target coverage was higher when larger planning TMs were used, but the correlation was loose due to the unpredictable, highly variable degree of implant-related volume increase. We currently are using 5-mm TMs around the GTV, as identified on pre-implant transrectal ultrasonography or computed tomography. However, the poor correlation between planned and actual post-implant TMs call into question any attempt to make a rational recommendation regarding optimal TMs.

Brachytherapy↗

PubMed2000

Patient perception of local anesthesia for prostate brachytherapy.

Prostate brachytherapy is an increasingly popular treatment for early-stage prostate cancer. Until now, spinal or general anesthesia for the procedure has been the standard of care. For patient safety, patient convenience, and to limit use of operating facilities, the authors started performing implants routinely with local anesthesia. We present here an evaluation of patients' acceptance of prostate brachytherapy under local anesthesia. On arrival at our department on the morning of the procedure, the patient is brought into the simulator suite, an intravenous line is started, and a urinary catheter is inserted. With the patient in the lithotomy position, a 5-by-5-cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 10 mL of 1% lidocaine, using a 25-gauge 5/8-inch needle. Immediately following injection into the subcutaneous tissues, the deeper tissues, including the pelvic floor and prostate apex, are anesthetized by injecting 15 mL lidocaine solution with approximately 8 passes of a 20-gauge 1-inch needle. Following subcutaneous and periapical lidocaine injections, the transrectal ultrasound (TRUS) probe is positioned to reproduce the planning images and a 3.5- or 6-inch, 22-gauge spinal needle is inserted into the peripheral planned needle tracks, monitored by TRUS. When the tips of the needles reach the prostatic base, about 1 mL of lidocaine solution is injected in the intraprostatic track, as the needle is slowly withdrawn. The lidocaine infiltration procedure takes approximately 10 to 15 minutes. Seed implantation is then performed as previously described. At the time of this report preparation, 58 of the 71 patients (81%) were interviewed, with a median follow-up of 6 months since the implant procedure. On a scale of 1 to 10, the median biopsy pain score was 4.5 compared with a median pain score with the implant procedure of 3.0. There was no clear correlation between the two scores (r = .26). There was no correlation between patients' implant pain score and the number of implant needles used, the pre-implant prostate size, or patient age. The prostate radiation dose coverage, calculated as the percent of the post-implant volume covered by the prescription isodose, averaged 88% (range, 75% to 99%). Five of the 55 patients interviewed (9%) stated that they would have preferred to have the procedure under general anesthesia. Ranked on a 1 to 5 scale, the median patient satisfaction was 5 and the average was 4.4. The substitution of local anesthesia has facilitated rapid introduction of a high-volume brachytherapy program at an institution, without requiring the allocation of significant operating room time. We are pleased with the overall level of patient comfort and satisfaction.

Aged↗

PubMed2000

Follow-up care for cancer: making the benefits equal the cost.

Posttreatment follow-up is a staple of oncologic practice. Clinicians have traditionally presumed that close surveillance improves clinical outcome. However, new evidence reveals that frequent, procedure-intensive follow-up may provide no more significant benefit to patients than simpler approaches. Several recent consensus recommendations from major oncology organizations support this theory. Published surveys of clinician and institutional follow-up policies reveal significant variations in practice, with many providers continuing to use costly, unproven regimens. This review highlights current data on follow-up care for three common cancers--breast, colorectal, and prostate. These data suggest an acute need for changes leading to more rational, consistent, and efficient follow-up practices.

Aftercare↗

PubMed1999

Prognostic role of serum prostatic acid phosphatase for 103Pd-based radiation for prostatic carcinoma.

PURPOSE: To establish the prognostic role of serum enzymatic prostatic acid phosphatase (PAP) in patients treated with palladium (103Pd) and supplemental external beam irradiation (EBRT) for clinically localized, high-risk prostate carcinoma. METHODS AND MATERIALS: One hundred twenty-four consecutive patients with Stage T2a-T3 prostatic carcinoma were treated from 1992 through 1995. Each patient had at least one of the following risk factors for extracapsular disease extension: Stage T2b or greater (100 patients), Gleason score 7-10 (40 patients), pretreatment prostate specific antigen (PSA) >15 ng/ml (32 patients), or elevated serum PAP (25 patients). Patients received 41 Gy conformal EBRT to a limited pelvic field, followed 4 weeks later by a 103Pd boost (prescription dose 80 Gy). Biochemical failure was defined as a PSA greater than 1 ng/ml (normal <4 ng/ml). RESULTS: The overall, actuarial freedom from biochemical failure at 4 years after treatment was 79%. In Cox-proportional hazard multivariate analysis, the strongest predictor of failure was elevated pretreatment acid phosphatase (p = 0.02), followed by Gleason score (p = 0.1), and PSA (p = 0.14). CONCLUSION: PAP was the strongest predictor of long-term biochemical failure. It may be a more accurate indicator of micrometastatic disease than PSA, and as such, we suggest that it be reconsidered for general use in radiation-treated patients.

Acid Phosphatase↗

PubMed1999

Prostate brachytherapy in patients with prior evidence of prostatitis.

PURPOSE: To refute a misconception that a prior history of prostatitis is a contraindication to prostate brachytherapy. METHODS AND MATERIALS: Five patients with clinical or pathologic evidence of prior prostatitis were treated with transperineal brachytherapy. Four of the patients received a single i.v. dose of ciprofloxacin (500 mg) intraoperatively. Postimplant antibiotics were not given. The pretreatment biopsy slides were reviewed. RESULTS: Two of the five patients developed postimplant urinary retention requiring short-term catheterization, and both resolved spontaneously. One patient developed what appeared to be an exacerbation of his chronic prostatitis. CONCLUSION: We continue to recommend prostate brachytherapy for the treatment of clinically organ-confined cancer, with no concern about prior clinical or pathologic evidence of prostatitis.

Aged↗

PubMed1999

Radiation safety parameters following prostate brachytherapy.

PURPOSE: To determine the degree and variability of radiation exposure to the general public from patients after I-125 or Pd-103 prostate brachytherapy. METHODS AND MATERIALS: Radiation exposure measurements were made from 38 consecutive, unselected patients with stage T1 or T2 prostatic carcinoma who had transperineal I-125 or Pd-103 implants at the University of Washington in 1998. RESULTS: The exposure rate at the anterior skin surface following a I-125 implant ranged from 2.2 to 8.9 mrem/hour (average: 5.0). The exposure rate at the anterior skin surface from a Pd-103 implant ranged from 0.5 to 4.9 mrem/hour (average: 1.7). Based on the current Nuclear Regulatory Commission (NRC) regulations the time required to reach the annual limit at the anterior skin surface would be 20 hours for I-125 and 59 hours for Pd-103. For exposure at the lateral skin surface, the times would exceed 500 hours for either isotope. CONCLUSIONS: This data suggest that patients need not be concerned about being a radiation risk to the general public following their procedure.

Brachytherapy↗

PubMed1999

Local anesthesia for prostate brachytherapy.

PURPOSE: To demonstrate the technique and feasibility of prostate brachytherapy performed with local anesthesia only. METHODS AND MATERIALS: A 5 by 5 cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 10 cc of 1% lidocaine with epinephrine, using a 25-gauge 5/8-inch needle. Immediately following injection into the subcutaneous tissues, the deeper tissues, including the pelvic floor and prostate apex, are anesthetized by injecting 15 cc lidocaine solution with approximately 8 passes of a 20-gauge 1.0-inch needle. Following subcutaneous and peri-apical lidocaine injections, the patient is brought to the simulator suite and placed in leg stirrups. The transrectal ultrasound (TRUS) probe is positioned to reproduce the planning images and a 3.5- or 6.0-inch, 22-gauge spinal needle is inserted into the peripheral planned needle tracks, monitored by TRUS. When the tips of the needles reach the prostatic base, about 1 cc of lidocaine solution is injected in the intraprostatic track, as the needle is slowly withdrawn, for a total volume of 15 cc. The implants are done with a Mick Applicator, inserting and loading groups of two to four needles, so that a maximum of only about four needles are in the patient at any one time. During the implant procedure, an additional 1 cc of lidocaine solution is injected into one or more needle tracks if the patient experiences substantial discomfort. The total dose of lidocaine is generally limited to 500 mg (50 ml of 1% solution). RESULTS: To date, we have implanted approximately 50 patients in our simulator suite, using local anesthesia. Patients' heart rate and diastolic blood pressure usually showed moderate changes, consistent with some discomfort. The time from first subcutaneous injection and completion of the source insertion ranged from 35 to 90 minutes. Serum lidocaine levels were below or at the low range of therapeutic. There has been only one instance of acute urinary retention in the patients treated so far, and no unplanned admissions to the hospital or need to reschedule a patient to be implanted under general or spinal anesthesia. CONCLUSIONS: The substitution of local anesthesia has facilitated rapid introduction of a high-volume brachytherapy program at an institution that previously had none, without requiring the allocation of significant operating room time. Although the patients reported here were implanted without conscious sedation, we are starting to try various sedatives and analgesics for patients who we anticipate will have substantial anxiety with the procedure.

Adrenergic Agonists↗

PubMed1999

Follow-up costs after external radiation for low risk prostate cancer.

PURPOSE: Some routine follow-up costs for external radiation for prostate cancer might not be justifiable. To study this possibility, we reviewed the follow-up costs and clinical course of 36 consecutive, unselected patients treated with external beam radiation (EBRT) for low-risk prostate cancer at the University of Washington. METHODS AND MATERIALS: Thirty-six consecutive patients with Stage T1/T2 prostate cancer and pretreatment prostate specific antigen (PSA) < 10 ng/ml were treated with EBRT with curative intent at the University of Washington from 1990 through 1996. All follow-up visits with each patient's urologist and radiation oncologist, and all laboratory tests were tabulated. Charges quoted in this report are based on University of Washington billing. RESULTS: A total of 8 patients demonstrated biochemical evidence of tumor progression/persistence, none of whom has had any therapeutic intervention for progressive cancer. No patient had local disease progression by physical examination. One patient experienced a Radiation Therapy Oncology Group (RTOG) grade 3 bowel complication (obstruction), not detected on routine follow-up. The average combined PSA and physician follow-up charges for the first 2 years after therapy was $1,013. CONCLUSION: The data presented here suggests that for low-risk prostate cancer (PSA < 10 ng/ml), frequent follow-up by physical examinations and PSAs during the first 2 years after therapy is not warranted.

Aged↗

PubMed1999

Tenascin-C is expressed in macrophage-rich human coronary atherosclerotic plaque.

BACKGROUND: Tenascin is a large extracellular matrix glycoprotein generally found in adult tissues undergoing active remodeling such as healing wounds and tumors. To determine the potential role of tenascin-C (TN-C) in the pathophysiology of atherosclerosis, we investigated the pattern of expression of TN-C in human coronary atherosclerotic plaques. METHODS AND RESULTS: Immunohistochemical staining and in situ hybridization demonstrated minimal and random expression of TN-C in fibrotic but lipid-poor atherosclerotic plaques. In contrast, all plaques with an organized lipid core or ruptured intimal surface strongly expressed TN-C, which was preferentially concentrated around the lipid core, shoulder regions, and ruptured area of the plaques but not in the fibrous cap. TN-C was not detected in normal arterial tissue. To identify the cellular source of TN-C, the plaques were stained with smooth muscle cell- and macrophage-specific antibodies. TN-C expression correlated with the infiltration of macrophages. Northern blot and immunoprecipitation analysis showed that macrophages expressed 7. 0-kb TN-C mRNA and 220-kDa protein. Reverse transcription-polymerase chain reaction of total RNA derived from macrophages showed that they express the small isoform of TN-C. Zymogram analysis revealed that macrophages markedly increased MMP-9 expression. CONCLUSIONS: This study demonstrates that the level of TN-C expression correlates with the degree of inflammation present, not with plaque size. In addition, cultured macrophages have the capacity to express the TN-C gene. These findings suggest the significance of macrophages in the remodeling of atherosclerotic plaque matrix composition.

Adult↗

PubMed1999

Use of TRUS to predict pubic arch interference of prostate brachytherapy.

PURPOSE: To demonstrate the potential for transrectal ultrasound (TRUS) to predict pubic arch interference of transperineal needle placement for prostate brachytherapy. METHODS AND MATERIALS: TRUS and pelvic computerized tomography (CT) scans from 22 patients who had transperineal prostate brachytherapy at University of Washington were analyzed for pubic arch visualization and interference. The outer margins of the prostate and the inner margins of the pubic bones from each imaging modality were outlined and compared. RESULTS: The pubic arch was readily visualized by TRUS in 21 of the 22 patients. There was good correlation between TRUS and CT for evaluating the amount of pubic arch interference (r = 0.90). CONCLUSION: TRUS can be substituted for CT imaging to evaluate pubic arch interference of transperineal needle placement for prostate brachytherapy. Eliminating routine CT scanning would reduce the cost of treatment.

Brachytherapy↗

PubMed1999

Use of pelvic CT scanning to evaluate pubic arch interference of transperineal prostate brachytherapy.

PURPOSE: To determine the necessity of preoperative evaluation of pubic arch interference in patients with small prostate volumes. METHODS AND MATERIALS: CT scans from 97 consecutive, unselected patients with stage T1 or T2 prostatic carcinoma who had transperineal I-125 or Pd-103 implants at the University of Washington in 1997 were analyzed for pubic arch interference. Transrectal ultrasound (TRUS) was performed with 6.0-MHz transducer with the patient in the lithotomy position and the patient's thighs vertical, similar to that used during the implant procedure. CT scans were obtained with the patient in the supine position, with 0.5-cm images taken at every 0.5 cm. To check for potential arch interference, the largest prostate cross-section was overlaid on the narrowest portion of the pubic arch. The overlap of the pubic arch and the prostate margin is measured at right angles to the inner pubic surface. The prostate volume obtained from the TRUS images was compared with the degree of pubic arch interference in order to determine whether TRUS volume predicted for interference. RESULTS: There was considerable variability in pubic arch interference between patients. The mm of pubic arch overlap with the prostatic margin varied from -11 mm to 20 mm. Patients with larger prostate volumes generally had more pubic arch interference, but the degree of interference was only loosely related to the prostate volume (r = 0.46). CONCLUSIONS: The degree of pubic arch interference is highly variable from one patient to the next and the TRUS volume cannot reliably predict patients who do or do not need a pelvic CT to detect potential arch interference.

Brachytherapy↗

PubMed1999

Comparability of CT-based and TRUS-based prostate volumes.

PURPOSE: To compare the prostate volumes defined by transrectal ultrasound (TRUS) versus computed tomographic (CT) scans used for brachytherapy planning. METHODS AND MATERIALS: Ten unselected patients underwent evaluation for prostate brachytherapy with TRUS and CT imaging. Axial prostate contours were obtained at 5-mm intervals in both studies. The CT images were photographed, scanned into a commercial software program, and reprinted from a laser printer at 600 dots per inch to provide individual images that were interpreted independently by the three physician authors (BK, KW, and JB). An effort was made to exclude pelvic floor muscles from the defined prostate contour. Volumes were calculated in cubic centimeters. The prostate volume and maximum dimension in each plane were compared for each imaging modality. RESULTS: The CT-based prostate volumes ranged from 31.1 cc to 48.1 cc. The TRUS-based volumes ranged from 26.6 cc to 46.4 cc. There was close agreement between imaging modalities (r = 0.9). The anterior-posterior, lateral, and craniocaudal prostatic dimensions were similar between modalities. To test for consistency between observers, the CT volumes were drawn independently by KB, KW, and JB. The prostatic measurements were consistent in all dimensions between observers. CONCLUSION: CT scan volumes and measurements correlate well with those obtained by TRUS, and are appropriate for pre- or postimplant dosimetry.

Brachytherapy↗

PubMed1999

Anticipating prostatic volume changes due to prostate brachytherapy.

The purpose of the study was to determine which clinical parameters might predict individual prostate volume changes from prostate brachytherapy. Fifty consecutive, unselected patients treated at the University of Washington by I-125 or Pd-103 implantation for prostatic carcinoma in 1998 were analyzed. The prostate contours on preimplant transrectal ultrasound (TRUS) images were digitized and the prostate volumes calculated. Postimplant axial CT images of the prostate was obtained at 0.5 cm intervals with patients in the supine position the morning after the implant. The postimplant prostate volume increased by an average factor of 1.7 (+/-0.34) compared with the preimplant volume, the size increase being primarily in the anterior-posterior dimension. The absolute volume change was similar in patients with small vs. large preimplant prostate volume (r = -0.39), but the proportional change was less in patients with a larger prostate volume (r = -0.71). Because patients with a small preimplant prostate had proportionately greater volume increase, their postimplant target coverage was generally less. No single parameter, including preimplant prostate volume, preimplant hormonal deprivation, or supplemental external beam radiation therapy (EBRT) can accurately predict the degree of swelling. The precise significance of and practical solution to implant-related prostate volume changes remains to be determined.

Brachytherapy↗

PubMed1999

Arterialization of human vein grafts is associated with tenascin-C expression.

OBJECTIVES: This study was performed to test the hypothesis that tenascin-C (TN-C), an extracellular matrix (ECM) protein with counteradhesive chemotactic and vascular growth-promoting effects, is expressed in "arterialized" human saphenous vein grafts (SVGs). BACKGROUND: Tenascin-C is expressed in the vessel wall after vascular injury in the experimental model, where it has been implicated in the formation of neointima. Overexpression of TN-C has also been implicated in the development and progression of pulmonary hypertension. Saphenous vein grafts are exposed to hemodynamic stress when interposed in the arterial circulation and mechanical stress upregulates expression of TN-C, whereas stress-relaxation suppresses its synthesis. We hypothesized that the hemodynamic stress of increased arterial pressure could also induce TN-C expression in SVG. METHODS: We examined the expression of TN-C protein and mRNA in normal vein and "arterialized" human SVG using immunohistochemistry and in situ hybridization, respectively. RESULTS: TN-C protein was not detected in control human saphenous veins; however, it was uniformly and strongly expressed in the adventitia and media of patent human vein grafts, with minimal or no expression in the neointima (n = 27, 100%). In situ hybridization showed that TN-C mRNA was not detected in the neointima, but was strongly upregulated in the adventitia and media, corroborating immunostaining data (n = 10, 100%). Unlike patent SVG, TN-C was not expressed in the adventitia of occluded grafts, except for a low level of expression around the newly formed vessels in neointima (n = 5, 100%). Smooth muscle cell-specific staining demonstrated that the lack of expression of TN-C in occluded vein grafts is not due to the lack of presence of smooth muscle cells in the graft. CONCLUSIONS: These findings suggest that placement of a venous graft in the arterial system leads to expression of TN-C, which may in turn facilitate graft remodeling. Conversely, loss of flow and intravascular pressure, associated with vein graft occlusion, is accompanied by disappearance of TN-C expression.

Arteries↗

PubMed1998

Radiographic findings and morbidity in patients treated with stereotactic radiosurgery.

PURPOSE: To determine the prognostic significance of pretreatment edema, lesion size and location on morbidity following stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Forty-seven evaluable patients with 63 lesions were treated on a 6-MV linear accelerator radiosurgery system at Memorial Sloan Kettering Cancer Center. All patients received a 10-mg intravenous bolus of dexamethasone sodium phosphate (Decadron) prior to SRS. Thirteen patients were treated for asymptomatic lesions while 34 were treated because of neurologic symptoms. The median dose delivered was 1800 cGy and the median prescription isodose curve was 85%. Pretreatment edema was measured on a transaxial T2-weighted MR image acquired within 1 month of the SRS. RESULTS: Ten patients experienced morbidity as a result of their treatment. The complication rate was measured by neurologic events following SRS and was not significantly influenced by the extent of peritumoral edema. Lesion size was also unrelated to the development of post-treatment symptoms as assessed by the ease of tapering steroids. The only parameter found to influence post-SRS complications was lesion location. Four of six (66%) patients treated to lesions in the motor cortex suffered post-SRS seizure activity, whereas only 6 of 37 (16%) patients treated to lesions elsewhere in the brain parenchyma experienced seizure activity. CONCLUSION: The presence of pretreatment edema and lesion size are not predictors of post-SRS complication rates or the ability to taper Decadron. Lesion location is predictive of post-SRS seizure activity.

Adolescent↗

PubMed1998

Clinical course of rectal bleeding following I-125 prostate brachytherapy.

PURPOSE: Despite the occurrence of some rectal complications in most large series of patients treated with radiation, there is surprisingly little information regarding their management. We report here the clinical course of such patients after I-125 brachytherapy, in an effort to help delineate a rational management policy. METHODS AND MATERIALS: 109 patients with stage T1 to T2 prostatic carcinoma and Gleason score 2 to 7 were treated with I-125 implantation from 1988 through 1995. No external radiation was given. The prescribed minimum radiation dose to the prostate was 140 to 160 Gy. RESULTS: Nineteen of 109 patients (actuarial incidence: 19%) developed persistent, bright red rectal bleeding, from 1 to 28 months following I-125 implantation. Most occurred in the early part of the implant experience. Bleeding resolved in 6 of the 19 patients, from 9 to 48 months from the time of onset. Nine patients were treated with steroid enemas. Laser coagulation was used in three patients, and six patients had no intervention. There was no obvious difference in the resolution rate between groups. There was no obvious difference in the rectal wall radiation for patients who did or did not experience resolution of their bleeding. CONCLUSION: Persistent, minor radiation-related bleeding after prostate brachytherapy can be a source of consternation to patients. They should be reassured that spontaneous healing is likely to occur eventually in a large portion of patients, and should be cautioned against invasive treatment, unless absolutely necessary.

Brachytherapy↗

PubMed1998

Urinary incontinence in patients who have a TURP/TUIP following prostate brachytherapy.

PURPOSE: To determine urinary morbidity in patients who have transurethral resection of the prostate (TURP) after 125I brachytherapy. MATERIALS AND METHODS: A total of 109 patients with Stage T1-T2 prostatic carcinoma were treated with 125I implantation from 1991 through 1995. Ten patients underwent TURP/transurethral incision of the prostate (TUIP) after brachytherapy to relieve urinary obstruction refractory to nonsurgical management. RESULTS: Patients who developed refractory urinary retention had a slightly larger preimplant prostate volume than those who did not (62 vs. 54 ml; p = 0.16). Seven of the 10 patients developed some degree of permanent urinary incontinence following TURP/TUIP. Urinary incontinence was mild in three patients [Late Effects Normal Tissue Radiation Oncology Group (LENT) score = 1] and severe in four additional patients (LENT score = 3). There was no obvious relationship between the degree of incontinence and use of TURP vs. TUIP, amount of tissue resected, or time between brachytherapy and TURP/TUIP. In five patients for whom detailed urethral radiation dose information was available, the doses were higher than generally recommended. CONCLUSION: Permanent urinary incontinence is common in patients who require a TURP or TUIP after prostate brachytherapy. Its cause is apparently multifactorial and may include the degree of physical damage to the urinary sphincters and the radiation dose to the urethral region.

Brachytherapy↗

PubMed1998

Prostate brachytherapy in patients with inflammatory bowel disease.

PURPOSE: There are minimal data to support the perceived contraindication of radiation therapy in patients with inflammatory bowel disease (IBD). Because of widespread concern about the possibility of radiation-related morbidity in IBD patients, the posttreatment course for 6 patients with a history of IBD who were treated with 125I prostate implantation for early stage prostate cancer are reported here. MATERIALS AND METHODS: Six patients with a prior history of IBD and Stage T1c-T2c prostatic carcinoma underwent 125I prostate brachytherapy from 1991-1996. Three patients had Crohn's disease and three had ulcerative colitis. The treatment plans were designed to treat the preimplant prostatic margin, as defined on planning CT scan, to 150 Gy. No special effort was made to minimize the rectal surface dose. Detailed records were available for all patients, and all patients were interviewed for this report. Follow-up ranged from 1 to 6 years (median: 3.7 years). RESULTS: None of the 6 patients experienced unusual or significant gastrointestinal side effects following implantation. All 6 patients remain free of GI complications. The rectal surface area that received > 100 Gy was kept below 10 mm2 in all patients, in accordance with previously published guidelines. CONCLUSIONS: Based on the limited information available, it appears that prostate brachytherapy is safe in patients with a history of IBD.

Adult↗