Advertisement

Successful use of tissue expander and pelvic sling to exclude small bowel for high-dose pelvic irradiation

  • Dedrick Kok Hong ChanEmail author
  • Timothy Cheo
  • Wai Kit Cheong
Original Article
  • 21 Downloads

Abstract

Objective

Our study seeks to describe our surgical technique of the use of a tissue expander and a pelvic sling in order to perform high-dose pelvic irradiation without incurring radiation toxicity to the small bowel.

Summary background data

High-dose radiation therapy for pelvic tumours comes at a risk of radiation toxicity to the small bowel. Our study discusses our novel surgical technique of compartmentalising the abdomen and the pelvis through the use of a tissue expander and pelvic sling to avoid small bowel radiation toxicity.

Methods

We present a patient with an unresectable sacral chordoma. We describe our surgical technique incorporating both a tissue expander and an absorbable pelvic mesh sling to successfully compartmentalise the abdomen from the pelvis.

Results

The patient underwent an uneventful surgical procedure to place the tissue expander within the pelvis and deploy the pelvic mesh sling. Following surgery, a separation of at least 8 cm was achieved between bowel loops and the tumour. A dose of 70 Gy delivered over 35 fractions using intensity modulated radiotherapy (IMRT) was administered to the sacral chordoma, whilst managing to constrain the maximum bowel dose to 35.7 Gy. Surgery to remove the tissue expander was uneventful. The patient has not suffered any small bowel irradiation toxicity.

Conclusions

Our technique to exclude small bowel from the pelvis is effective and safe. This technique not only can be applied in the setting of unresectable sacral chordomas but also may be applicable to other pelvic cancers which require radiation therapy.

Keywords

Tissue expander Pelvic sling High-dose radiation therapy Pelvic sarcoma 

Notes

Author’s contribution

All authors are in agreement with this paper.

Dedrick Kok Hong Chan contributed to the data collection and analysis, revision of manuscript, and final approval of the manuscript.

Timothy Cheo contributed to the data interpretation, drafting and revision of manuscript, and final approval of the manuscript.

Wai Kit Cheong contributed to the data interpretation, drafting and revision of manuscript, and final approval of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent statement

Written consent was obtained from the patient for publication of this report and any accompanying images.

References

  1. 1.
    Chambers KJ, Lin DT, Meier J, Remenschneider A, Herr M, Gray ST (2014) Incidence and survival patterns of cranial chordoma in the United States. Laryngoscope. 124(5):1097–1102CrossRefGoogle Scholar
  2. 2.
    McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM (2001) Chordoma: incidence and survival patterns in the United States, 1973–1995. Cancer Causes Control 12(1):1–11CrossRefGoogle Scholar
  3. 3.
    Sciubba DM, Chi JH, Rhines LD, Gokaslan ZL (2008) Chordoma of the spinal column. Neurosurg Clin N Am 19(1):5–15CrossRefGoogle Scholar
  4. 4.
    Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ (2012) Chordoma: current concepts, management, and future directions. Lancet Oncol 13(2):e69–e76CrossRefGoogle Scholar
  5. 5.
    Tobias CA, Lyman JT, Chatterjee A, Howard J, Maccabee HD, Raju MR, Smith AR, Sperinde JM, Welch GP (1971) Radiological physics characteristics of the extracted heavy ion beams of the bevatron. Science. 174(4014):1131–1134CrossRefGoogle Scholar
  6. 6.
    Coia LR, Myerson RJ, Tepper JE (1995) Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys 31(5):1213–1236CrossRefGoogle Scholar
  7. 7.
    Letschert JG, Lebesque JV, de Boer RW, Hart AA, Bartelink H (1990) Dose-volume correlation in radiation-related late small-bowel complications: a clinical study. Radiother Oncol 18(4):307–320CrossRefGoogle Scholar
  8. 8.
    Gunnlaugsson A, Kjellén E, Nilsson P, Bendahl PO, Willner J, Johnsson A (2007) Dose-volume relationships between enteritis and irradiated bowel volumes during 5-fluorouracil and oxaliplatin based chemoradiotherapy in locally advanced rectal cancer. Acta Oncol 46(7):937–944CrossRefGoogle Scholar
  9. 9.
    Stacchiotti S, Sommer J (2015) Chordoma Global Consensus Group. Building a global consensus approach to chordoma: a position paper from the medical and patient community. Lancet Oncol 16(2):e71–e83CrossRefGoogle Scholar
  10. 10.
    Mima M, Demizu Y, Jin D, Hashimoto N, Takagi M, Terashima K, Fujii O, Niwa Y, Akagi T, Daimon T, Hishikawa Y, Abe M, Murakami M, Sasaki R, Fuwa N (2014) Particle therapy using carbon ions or protons as a definitive therapy for patients with primary sacral chordoma. Br J Radiol 87(1033):20130512CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Colorectal Surgery, University Surgical ClusterNational University Health SystemSingaporeSingapore
  2. 2.Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  3. 3.Department of Radiation OncologyNational University Cancer InstituteSingaporeSingapore

Personalised recommendations