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Patient-related risk factors for late rectal bleeding after hypofractionated radiotherapy for localized prostate cancer: a single-center retrospective study

  • Kim, Tae Gyu1
  • Park, Byungdo1
  • Song, Yun Gyu1
  • Lee, Hyoun Wook1
  • Oh, Tae Hee1
  • Ryu, Dong-Soo1
  • Jeong, Seung Chan1
  • Cho, Daehyeon1
  • Oh, Jieun1
  • Kim, Kwang Min1
  • Lee, Jung Won1
  • Lee, Hyoun Soo1
  • Kong, Sung Min1
  • Kim, Jun Young1
  • Kim, Haeyoung2
  • 1 Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, 630-522, South Korea , Changwon (South Korea)
  • 2 Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea , Seoul (South Korea)
Published Article
Radiation Oncology
Springer (Biomed Central Ltd.)
Publication Date
Feb 09, 2022
DOI: 10.1186/s13014-022-01998-4
Springer Nature
  • Clinical Radiation Oncology


BackgroundSeveral studies have reported patient-related risk factors for late rectal bleeding following conventionally fractionated radiotherapy for prostate cancer. We investigated patient-related risk factors for late rectal bleeding after hypofractionated radiotherapy.MethodsA total of 231 patients with local or locally advanced prostate cancer treated with hypofractionated radiotherapy (70 or 67.2 Gy in 28 fractions) were evaluated retrospectively. All patients received intensity-modulated radiotherapy with daily image guidance. The relationships between late rectal bleeding and risk factors like diabetes, hypertension, cirrhosis, and anticoagulant use were analyzed.ResultsDuring a median follow-up of 23 months, the crude rates of grade ≥ 1, grade ≥ 2, and grade ≥ 3 late rectal bleeding were 23.8%, 16.9%, and 9.5%, respectively. Cirrhosis and anticoagulant use predicted an increased risk of grade ≥ 3 rectal bleeding in multivariable analyses (hazard ratio [HR] 14.37, 95% confidence interval [CI] 3.09–66.87, P = 0.001, and HR 2.93, 95% CI 1.14–7.55, P = 0.026, respectively). The non-anticoagulant group had a significantly superior 5-year freedom from grade ≥ 3 bleeding compared to the anticoagulant group in a propensity-weighted log-rank analysis (88.0% vs. 76.7%, P = 0.041). A receiver operating characteristic curve analysis revealed that rectal bleeding was minimized in the anticoagulant group if the equivalent dose at fractionation of 2 Gy (EQD2) V77 Gy of the rectum was < 4.5% or if the EQD2 V8.2 Gy was < 71.0%.ConclusionsPatients taking anticoagulants or those with cirrhosis had a significantly higher risk of severe late rectal bleeding than other patients after hypofractionated radiotherapy for prostate cancer in the present study. The bleeding risk could be lowered by minimizing hotspots in patients taking anticoagulants.

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