Abstract
INTRODUCTION: Prostate cancer is the most common cancer of males in the United States. One treatment modality for localized prostate cancer is brachytherapy, the implantation of radioactive seeds directly into the prostate. Although this is an effective treatment option, significant complications can result. More commonly these complications involve the genitourinary tract, but radiation proctitis is a well-recognized, less common complication. A specific complication of brachytherapy, the development of a rectal ulcer is not well recognized. The clinical course of this complication and results of treatment options are unknown. METHODS: Three cases of rectal ulceration as a consequence of prostatic brachyradiotherapy are presented, and the presumed course of disease and treatment options is discussed. RESULTS: Two patients were initially treated with local advancement flaps that both failed. These patients developed rectourethral fistulas. One patient was treated with diverting colostomy and suprapubic urinary diversion. The second underwent proctectomy and coloanal anastomosis. This also failed after multiple attempts to treat perianastomotic fistulas. The third patient was treated endoscopically for bleeding and has had no further interventions. CONCLUSION: In the small percentage of patients who develop rectal ulcerations from prostatic brachyradiotherapy, local medical or surgical treatments will often result in failure. They also may contribute to the eventual development of rectourethral fistulas, the likely natural progression of this disease. These fistulas should be treated with both urinary and fecal diversion. Earlier stages of ulceration may be treated with rectal resection and reconstruction, but selection criteria for these procedures have yet to be determined.
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References
H Ragde J Blasko P Grimm et al. (1997) ArticleTitleBrachytherapy for clinically localized prostate cancer Semin Surg Oncol 13 438–443
M Zelefsky T Hollister A Raben et al. (2000) ArticleTitleFive-year biochemical outcome and toxicity with transperineal CT-planned permanent I-125 prostate implantation for patients with localized prostate cancer Int J Radiat Biol Phys 47 1261–1266
K Wallner J Roy L Harrison (1996) ArticleTitleTumor control and morbidity following transperineal I-125 implantation for T1/T2 prostatic carcinoma J Clin Oncol 14 449–453
JC Blasko PD Grimm H Ragde (1993) ArticleTitleBrachytherapy and organ preservation in the management of carcinoma of the prostate Semin Radiat Oncol 3 240–249
TJ Saclarides DG King JL Franklin A Doolas (1996) ArticleTitleFormalin instillation for refractory radiation-induced hemorrhagic proctitis Dis Colon Rectum 39 196–199
KN Buchi JA Dixon (1987) ArticleTitleArgon laser treatment of hemorrhagic radiation proctitis Gastrointest Endosc 33 27–30
J Sylvester J Blasko P Grimm H Ragde (1997) ArticleTitleInterstitial implantation techniques in prostate cancer J Surg Oncol 66 65–75
H Ragde L Korb (2000) ArticleTitleBrachytherapy for clinically localized prostate cancer Semin Surg Oncol 18 45–51
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Celebrezze, J.P., Medich, D.S. Rectal Ulceration as a Result of Prostatic Brachytherapy: A New Clinical Problem. Dis Colon Rectum 46, 1277–1279 (2003). https://doi.org/10.1007/s10350-004-6726-7
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DOI: https://doi.org/10.1007/s10350-004-6726-7