Minimal Rectal Toxicity in the Setting of Comorbid Crohn's Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer.

Raj Singh,Sanjeev Sharma,Mollie Blake,Philip S Jackson,James Cutlip

doi:10.7759/cureus.1533

Raj Singh, Sanjeev Sharma + Show 3 more

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https://doi.org/10.7759/cureus.1533

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Journal: Cureus	Publication Date: Aug 1, 2017
Citations: 4	License type: cc-by

Affiliation: Marshall University, Virginia Commonwealth University

Abstract

We present one of the first cases of a prostate cancer (PCa) patient with inflammatory bowel disease (IBD) treated with intensity-modulated radiotherapy (IMRT) and a hydrogel rectal spacer. A 73-year-old male with a past medical history significant for Crohn’s disease (CD) and the recent diagnosis of T1cN0M0 high-risk PCa was referred for definitive radiotherapy. Given the patient’s history of CD and the possible increased risk of gastrointestinal (GI) toxicity and disease exacerbation, prior to IMRT, a hydrogel spacer was placed between the prostate and the anterior rectal wall to further minimize irradiation to the rectum. The patient then received IMRT (78 Gy/2 Gy fractions at a 100 percent isodose line). Over the course of treatment, Radiation Therapy Oncology Group (RTOG) Grade 1 GI toxicities of mild diarrhea were noted during the fifth and sixth weeks of treatment as well as an RTOG Grade 1 genitourinary (GU) toxicity of a decrease in the urinary stream that resolved with tamsulosin. At the 3, 6, 9, and 12-month follow-ups, bowel movements and urinary stream were reported to be at baseline with prostate-specific antigen (PSA) levels of 0.18 ng/mL and 0.03 ng/mL at the three and nine-month follow-ups, respectively. As such, this case report suggests that IBD patients with localized PCa may be viable candidates for radiotherapy given the promising results of hydrogel spacers in combination with IMRT in limiting rectal toxicity.

Highlights

External beam radiotherapy (RT) is commonly used in the treatment of clinically localized prostate cancer (PCa)
The disadvantages of RT include possible genitourinary (GU) and gastrointestinal (GI) symptoms [1]. This is especially relevant for PCa patients with inflammatory bowel disease (IBD), as IBD is considered to be a relative contraindication of RT because of the possible increased risk of GI toxicity and subsequent disease exacerbation [2]
We present one of the first cases of a PCa patient with IBD treated with intensity-modulated radiation therapy (IMRT) and a hydrogel rectal spacer

Summary

Introduction

External beam radiotherapy (RT) is commonly used in the treatment of clinically localized prostate cancer (PCa). How to cite this article Singh R, Jackson P S, Blake M, et al (August 01, 2017) Minimal Rectal Toxicity in the Setting of Comorbid Crohn’s Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer. Given that the VMAT plan without the spacer was simulated using a diagnostic CT, no bowel prep was utilized and this may be responsible for the differing isodose lines and, subsequently, the relatively higher doses received by larger rectal volumes with the rectal spacer. RTOG Grade 1 GU toxicities of mild decreases in urinary stream were reported during the third week of treatment, which resolved with tamsulosin at subsequent follow-ups. One week following the completion of treatment, the patient reported an RTOG Grade 1 GI toxicity of mild diarrhea. PSA levels of 0.18 ng/mL and 0.03 ng/mL were noted at the three-month and nine-month follow-ups, respectively

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Disclosures