Spontaneous Healing Of Rectal Penetration By Spaceoar® Hydrogel Insertion During Permanent Iodine-125 Implant Brachytherapy: A Case Report
Iinuma, K., Mizutani, K., Kato, T., Nakane, K., Tanaka, H., Nakano, M., Matsuo, M., & Koie, T. (2019). Spontaneous healing of rectal penetration by SpaceOAR® hydrogel insertion during permanent iodine-125 implant brachytherapy: A case report. Molecular and clinical oncology, 11(6), 580–582. https://doi.org/10.3892/mco.2019.1937
View Original Source →Abstract
Radiation therapy with permanent iodine-125 implant brachytherapy is well established for curable prostate cancer. To maximize the therapeutic potential of brachytherapy, delivered radiation doses have been increased accompanied by refined intraoperative procedures of radioactive seeds placement. However, dose escalation is a double-edged sword in prostate brachytherapy; it could induce rectal toxicity, yet is successful in curable treatment in prostate cancer. To reduce irradiation of the rectum, the SpaceOAR® system has been used to inject synthetic polyethylene glycol hydrogel between the prostate and the rectum. The present report describes a case of spontaneous healing of rectal penetration associated with SpaceOAR® hydrogel.
Case Details
Disease Location
Rectum
Personal Characteristics
63-year-old man. History of sigmoidecomy
Clinical Characteristics
With a previous sigmoidectomy due to diverticular perforation presented with a serum prostate‐specific antigen level of 7.17 ng/ml. MRI revealed the suspicion of prostate cancer in the transitional zone of the left lobe. The patient underwent prostate biopsy, and histological examination of the specimen was interpreted as multifocal adenocarcinoma of the prostate. Colonofiberoscopy (cf) was performed prior to permanent iodine-125 implant brachytherapy (pi) and showed no abnormal findings such as hemorrhoids or rectal tumor. Pi was performed with 60 radioactive iodine-125 seeds using the ultrasonography-guided intraoperative transperineal technique. Spaceoar® hydrogel was injected into the space between the prostate and the anterior rectal wall. One month after implantation, the patient complained of repeated incidents of mucous and blood in his stool and underwent another cf, which confirmed the presence of mucosal ulceration and necrosis of the anterior rectal wall. MRI indicated penetration of the rectum to the retroperitoneal space, where the hydrogel was injected
Remission Characteristics
Complete healing was confirmed by both cf and MRI one month after the diagnosis of penetration
Treatment & Mechanisms
Clinical Treatment
Biopsy, permanent iodine-125 implant brachytherapy, spaceoar® hydrogel