• Osamu Suzuki, Yasuo Yoshioka, Fumiaki Isohashi, Masahiro Morimoto, Tadayuki Kotsuma, Yoshifumi Kawaguchi, Koji Konishi, Satoaki Nakamura, Hiroya Shiomi, and Takehiro Inoue.
• Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari, Osaka, Japan. suzuki-os@mc.pref.osaka.jp
• Int. J. Radiat. Oncol. Biol. Phys. 2008 Aug 1; 71 (5): 1329-34.

PurposeThis retrospective study analyzed the effect of the activity of high-dose-rate (HDR) (192)Ir source on late rectal bleeding after HDR intracavitary radiotherapy (ICRT) in patients with uterine cervix cancer.Methods And MaterialsOne hundred thirty-two patients who underwent HDR-ICRT and external beam radiotherapy (EBRT) were analyzed. The rectal point dose in ICRT was calculated by inserting a lead wire into the rectal lumen and summed with the whole-pelvic EBRT dose. The rectal biologic effective dose (BED) was calculated. The relationship between averaged source activity or the BED and late rectal bleeding were analyzed.ResultsThree-year actuarial rectal bleeding probabilities were 46% (> or =100 Gy(3)) and 18% (< or = 100 Gy(3)), respectively (p < 0.005). When patients were divided into four groups according to rectal BED (> or = or < or =100 Gy(3)) and source activity (> or = or < or =2.4 cGy.m(2).h(-1)), the group with both a high BED and high activity showed significantly greater probability (58% at 3 years; p < 0.005). It was noted that the probability of the group with BED of 100 Gy(3) or greater was high, but that was not the case with 2.4 cGy.m(2).h(-1) or less.ConclusionThis is the first clinical report concerning the source activity effect of HDR (192)Ir on late rectal bleeding in patients undergoing HDR-ICRT. This suggests that when source activity is higher than 2.4 cGy.m(2).h(-1), ICRT should be performed with more caution not to exceed 100 Gy(3) in total.

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