Spontaneous Remission Of Rectal Ulcer Associated With Spaceoar® Hydrogel Insertion In Radiotherapy For Prostate Cancer
Imai, K., Sakamoto, H., Akahane, M., Nakashima, M., Fujimoto, T., & Aoyama, T. (2020). Spontaneous remission of rectal ulcer associated with SpaceOAR® hydrogel insertion in radiotherapy for prostate cancer. IJU case reports, 3(6), 257–260. https://doi.org/10.1002/iju5.12209
View Original Source →Abstract
INTRODUCTION: The SpaceOAR® hydrogel system separates the prostate and rectum to reduce rectal irradiation during prostate radiotherapy. However, it could induce rectal toxicity. CASE PRESENTATION: A 75-year-old man with localized prostate cancer underwent external beam radiotherapy with the use of SpaceOAR® System. However, postimplant magnetic resonance imaging showed hydrogel infiltration to the rectum. Three months after implantation, he complained of bowel symptoms, including bloody stool. Colonofiberscopy and computed tomography revealed a rectal ulcer associated with SpaceOAR® hydrogel insertion. He was treated with fasting, fluid replacement, and blood transfusion. One year after implantation, complete healing was confirmed during outpatient follow-up. CONCLUSION: To our knowledge, this is the first report of a rectal ulcer associated with SpaceOAR® hydrogel insertion assessed by magnetic resonance imaging beforehand. Postimplant magnetic resonance imaging evaluation might be a useful follow-up tool in such cases.
Case Details
Disease Location
Anus
Personal Characteristics
75-year-old man. History of brain infarction, atrial fibrillation, chronic heart failure, and glaucoma
Clinical Characteristics
With a prostate-specific antigen level of 9.1 ng/ml underwent a prostate biopsy and was diagnosed with low-risk prostate cancer. MRI revealed the suspicion of cancer in the transitional zone of the left prostate lobe. External beam radiotherapy (ebrt) using the spaceoar® system was planned. Spaceoar® hydrogel insertion using an ultrasound-guided transperineal technique under spinal anesthesia was performed. The next day, postimplant MRI images showed that some spaceoar® hydrogel had infiltrated his anterior rectal wall. He underwent ebrt; a total dose of 74 gy in 37 fractions was delivered to his prostate gland as planned. On his visit at 3 months after implantation, he complained of increased bowel frequency, urgency, and intermittent pain around his anus. Six months after implantation, he complained of bloody stools.an enhanced abdominal CT scan revealed air in the space between the prostate and anterior rectal wall that was inconsistent with contamination during the insertion procedure. Colonofiberscopy (cf) revealed an ulcer with an exposed vessel at the anterior rectal wall. No findings indicated proctitis. He was diagnosed with a rectal ulcer and hospitalized for careful monitoring. Treatment was conservative: fasting, fluid infusion, and blood transfusion.
Remission Characteristics
Five days after diagnosis, follow-up cf, the previously exposed vessel was not observed, and the rectal ulcer did not get worse. On a subsequent follow-up cf, 34 days after diagnosis of his ulcer, mucosal restoration was observed. Six months after diagnosis (1 year after implantation), epithelialization was observed, which was consistent with healing
Treatment & Mechanisms
Clinical Treatment
Biopsy, hydrogel implantation, fluid infusion, blood transfusion
Non-Clinical Treatment
Fasting