Minimal Rectal Toxicity in the Setting of Comorbid Crohn’s Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer

Singh, Raj; Jackson, Patrick N. Wyse; Blake, Mollie; Cutlip, James; Sharma, Sanjeev

doi:10.7759/cureus.1533

Cited by 3 publications

(6 citation statements)

References 10 publications

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“…37,38 Interestingly, there have been a few case reports of IBD patients achieving successful oncologic outcomes with minimal IBD flare-ups from prostate cancer radiotherapy after SpaceOAR placement. [39][40][41] These case reports suggest that the IBD patients with localized prostate cancer may be viable candidates for radiotherapy after SpaceOAR placement.…”

Section: Discussionmentioning

confidence: 82%

Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: A systematic review

Babar¹,

Katz

Ciatto³

2021

J Med Imag Rad Onc

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SpaceOAR, an absorbable polyethylene glycol hydrogel, increases the space between the prostate and rectum to reduce the radiation received by the rectum during prostate cancer radiation therapy. The objective of this systematic review was to evaluate controlled studies on the dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer. Eight studies were included in the review. All of the studies showed SpaceOAR to reduce the radiation dose volume to the rectum over numerous dosimetry levels. Of the four studies that assessed toxicity, one reported SpaceOAR to significantly decrease acute Grade 1 diarrhoea and two reported SpaceOAR to significantly decrease late Grade 1 and Grade ≥2 rectal toxicities. Two studies assessed cumulative incidence of toxicity at 3 years in which one reported SpaceOAR to significantly decrease urinary incontinence and Grade ≥1 and Grade ≥2 rectal toxicities, and the other reported SpaceOAR to significantly decrease Grade 1 diarrhoea and Grade 2 proctitis. Moreover, one study reported that fewer SpaceOAR patients experienced 10-point declines in bowel quality of life at 3 years, but another study reported no significant difference in 10-point declines in bowel quality of life between the SpaceOAR and control groups at 5 years. With the current research available, SpaceOAR may be beneficial to those who did not meet the standard rectal dose-volume criteria, have higher risk factors of developing rectal toxicities post-radiation, or wish to decrease the length and costs of radiotherapy by increasing the dose of radiation per fraction.

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Section: Discussionmentioning

confidence: 82%

Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: A systematic review

Babar¹,

Katz

Ciatto³

2021

J Med Imag Rad Onc

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“…Lehrich et al . reported on patients with prostate cancer and IBD, with 70% receiving a hydrogel rectal spacer at the time of EBRT with HDR-BT boost [ 7 , 23 ]. No patient experienced severe acute or late proctitis or diarrhea [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…One study found an overall incidence of severe toxicity of 46% following abdominal and pelvic irradiation among patients with IBD, with 21% experiencing acute enteral toxicity that necessitated cessation of RT, and late toxicity requiring hospitalization or laparotomy due to complications of the small or large bowel [ 5 ]. Existing literature on the safety of EBRT in IBD patients with prostate cancer shows an association between EBRT and increased risk of gastrointestinal (GI) toxicity, though perhaps somewhat mitigated with the use of a hydrogel rectal spacer [ 6 , 7 ]. While advancements in radiation techniques have enabled more targeted delivery, EBRT still exposes the rectal-prostate interface and surrounding tissues in the lower pelvis to significant radiation.…”

Section: Purposementioning

confidence: 99%

Safety of high-dose-rate brachytherapy in patients with prostate cancer and inflammatory bowel disease: A case series

Thomas,

Chen,

Shaheen

et al. 2024

jcb

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Introduction Inflammatory bowel disease (IBD) is a relative contraindication to external beam radiation therapy (EBRT) for prostate cancer patients due to fear of increased risk of gastrointestinal (GI) toxicity. High-dose-rate (HDR) brachytherapy, capable of minimizing radiation dose to surrounding tissues, is a feasible alternative. Given limited data, this study examined the safety profile of HDR brachytherapy in this setting. Material and methods We conducted a retrospective review of patients with localized prostate cancer and IBD treated with HDR brachytherapy at the University of California San Francisco (UCSF), between 2010 and 2022. Eligibility criteria included biopsy-proven prostate cancer, no distant metastases, absence of prior pelvic radiotherapy, IBD diagnosis, and at least one follow-up visit post-treatment. Results Eleven patients were included, with a median follow-up of 28.7 months. The median dose administered was 2700 cGy (range, 1500-3150 cGy) over 2 fractions (range, 1-3 fractions). Two patients also received EBRT. Rectal spacers (SpaceOAR) were applied in seven patients. All patients experienced acute genitourinary (GU) toxicity, ten of which were grade 1 and one was grade 2. Eight patients experienced late grade 1 GU toxicity, and three patients had late grade 2 GU toxicity. GI toxicities were similarly low-grade, with six grade 1 acute toxicity, no grade 2 or higher acute toxicity, six grade 1 late toxicity, and one late grade 2 GI toxicity. No grade 3 or higher acute or late GI or GU toxicities were reported. Conclusions HDR brachytherapy appears to be a safe and tolerable treatment modality for patients with prostate cancer and IBD, with minimal acute and late GI and GU toxicity. These findings warrant multi-institutional validation due to small sample size.

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“…Moreover, recent publications reported reduced risk of rectal toxicities in patients with IBD with placement of rectal spacers to displace the anterior rectal wall out of the field of radiation ( 102 - 105 ). In a case report, the use of hydrogel spacer in a patient with IBD and PCa treated with IMRT resulted in reduced rectal dose from 78.7 to 60.4 Gy, without and with the hydrogel spacer, respectively, resulting in Grade 1 GI toxicities of mild diarrhea.…”

Section: Ibd-associated Malignancies With Proximity To Bowelmentioning

confidence: 99%

“…In a case report, the use of hydrogel spacer in a patient with IBD and PCa treated with IMRT resulted in reduced rectal dose from 78.7 to 60.4 Gy, without and with the hydrogel spacer, respectively, resulting in Grade 1 GI toxicities of mild diarrhea. ( 102 ) One center treating 8 patients with IMRT and HDR brachytherapy boost with an injectable hydrogel spacer, with minimal acute toxicities and no late grade ≥2 gastrointestinal toxicities in the median 36 month follow up period ( 105 ). Similarly, the toxicity profile with the use of biodegradable rectal balloon implants inflated with saline is favorable and can be utilized in both the EBRT and brachytherapy setting ( 103 , 104 ).…”

Section: Ibd-associated Malignancies With Proximity To Bowelmentioning

confidence: 99%

Inflammatory bowel disease-associated malignancies and considerations for radiation impacting bowel: a scoping review

Bodofsky¹,

Freeman²,

Hong³

et al. 2022

J Gastrointest Oncol

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Background: Inflammatory bowel disease (IBD), subdivided into Crohn's disease (CD) and ulcerative colitis (UC), is an auto-inflammatory gastrointestinal condition with an established increased risk of certain malignancies. Compared to sporadic cancers in the general population, IBD-associated malignancies present unique challenges to providing quality care. Radiation therapy (RT) targeting IBD-associated malignancies may directly impact inflamed bowel, with special considerations for the risk of toxicities. Historically, patients with IBD have been less likely to receive radiotherapy in proximity to bowel due to a poor understanding of the potential for acute and chronic toxicities and unclear treatment outcomes. We present a scoping review, to more fully assess IBD-associated malignancies and their treatment. As opposed to a systematic review, this approach allows us to analyze the broadest range of literature, including experimental and non-experimental research, and reflect on current guidelines and practices.Methods: Literature search: a systematic, scoping search of published literature was conducted using applicable PRISMA scoping review (ScR) guidelines. The literature search was conducted on PubMed and was searched systematically by screening all publications from January 1990 to June 2021. Citations from the included articles were also manually searched. Relevant National Comprehensive Cancer Network guidelines were reviewed. Final query was December 2021 in editing. Articles were selected for full text reading if the abstract reported on malignancy in IBD or bowel toxicities. Results:The pelvic malignancies found in the IBD patient population, including colorectal carcinoma, anal carcinoma, lymphoma, small bowel adenocarcinoma (SBA), and prostate cancer (PCa) are outlined in this scoping review. Additional cancers that have a contested relationship with IBD, including cervical, bladder, and upper GI cancers, are also explored. This review provides literature guided recommendations on the eligibility of patients with IBD to receive RT, management of IBD during and after treatment, and counseling for radiation-induced toxicities.Conclusions: After review of the literature, IBD should not be considered an absolute contraindication to radiation therapy, given the lack of evidence for increased toxicities, and the evolution of RT techniques which limit radiation dose to the bowel.

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Minimal Rectal Toxicity in the Setting of Comorbid Crohn’s Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer

Cited by 3 publications

References 10 publications

Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: A systematic review

Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: A systematic review

Safety of high-dose-rate brachytherapy in patients with prostate cancer and inflammatory bowel disease: A case series

Inflammatory bowel disease-associated malignancies and considerations for radiation impacting bowel: a scoping review

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