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Lethal outcome after pelvic salvage radiotherapy in a patient with prostate cancer due to increased radiosensitivity

Case report and literature review

Salvage-Strahlentherapie am Becken mit letalem Ausgang aufgrund erhöhter Strahlenempfindlichkeit bei einem Patienten mit Prostatakarzinom

Fallbericht und Literaturüberblick

  • Case Study
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background

In general, late side effects after salvage radiotherapy (RT) for prostate cancer are below 10%. Patients with impaired DNA repair ability and genetic instability can have significantly increased reactions after RT.

Case, clinical follow-up, and examination

We present a patient who experienced severe side effects after additive RT for prostate cancer and died from the complications 25 months after RT. Imaging (MR) is shown as well as three-color fluorescence in situ hybridization. The blood sample testing revealed that radiosensitivity was increased by 35–55%. We undertook a review of the literature to give an overview over the tests established that are currently considered useful.

Conclusion

This case highlights that the identification of patients with increased radiosensitivity is an important task in radiation protection. Groups of patients who should be screened have to be found and corresponding research facilities have to be set up.

Zusammenfassung

Hintergrund

Generell sind späte Nebenwirkungen nach additiver Radiotherapie (RT) beim Prostatakarzinom mit deutlich unter 10 % selten. Allerdings haben Patienten mit eingeschränkter DNA-Reparatur-Kapazität und genetischer Instabilität ein signifikant erhöhtes Nebenwirkungsrisiko.

Fallbericht, Follow-up und Untersuchungsergebnisse

In diesem Fallbeispiel stellen wir einen Patienten vor, der nach additiver RT wegen Prostatakarzinom massive Nebenwirkungen erlitt und 25 Monate nach der RT daran verstarb. Wir zeigen die Ergebnisse der konsekutiven MR-Untersuchungen und 3‑Farben-Fluoreszenz-in-situ-Hybridisierung. Die Blutuntersuchung ergab eine um 35–55 % erhöhte Strahlenempfindlichkeit. Eine aktuelle Literaturrecherche ergab, dass mittlerweile verschiedene Testverfahren zur Untersuchung der Strahlenempfindlichkeit etabliert sind.

Schlussfolgerung

Das Fallbeispiel zeigt, dass die Identifikation besonders strahlenempfindlicher Patienten ein wichtiges Arbeitsziel im Strahlenschutz ist. Patientenparameter für eine erforderliche Testung über die bekannten Syndrome hinaus sollten identifizierbar werden. Entsprechende Forschungseinrichtungen sind zu etablieren.

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Authors and Affiliations

  1. Klinik und Praxis für Radioonkologie und Strahlentherapie, Klinikum Bamberg, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany

    Antje Fahrig &  T. Koch

  2. Klinik für Diagnostische Radiologie, Interventionelle Radiologie und Neuroradiologie, Klinikum Bamberg, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany

    M. Lenhart

  3. Neurologische Klinik, Klinikum Bamberg, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany

    P. Rieckmann

  4. Strahlenklinik, Universitätsklinikum Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany

    R. Fietkau,  Luitpold Distel & B. Schuster M.Sc.

Authors
  1. Antje Fahrig
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  2. T. Koch
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  3. M. Lenhart
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  4. P. Rieckmann
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  5. R. Fietkau
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  6. Luitpold Distel
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  7. B. Schuster M.Sc.
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Correspondence to Antje Fahrig.

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Fahrig, A., Koch, T., Lenhart, M. et al. Lethal outcome after pelvic salvage radiotherapy in a patient with prostate cancer due to increased radiosensitivity. Strahlenther Onkol 194, 60–66 (2018). https://doi.org/10.1007/s00066-017-1207-9

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  • DOI: https://doi.org/10.1007/s00066-017-1207-9

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