Necrotising fasciitis secondary to locally advanced rectal cancer

Woodcock, NP; Sebag‐Montefiore, David; Mannion, RA; Dj, Alexander; Miller, GV

doi:10.1308/147870806x95249

Cited by 3 publications

(2 citation statements)

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“…In the Corner study [3] rectal bleeding was controlled in 63% of advanced inoperable rectal carcinomas; the median duration of the symptom response was 3 months, using a single 10 Gy dose. A retrospective study [5] demonstrated improved bleeding in the palliative group (n=22) with a 64% response rate obtained, including 57% complete responses. A mucous discharge was reported in 64% of cases with 28% complete responses.…”

Section: Discussionmentioning

confidence: 98%

“…The aim of using endoluminal brachytherapy is to improve quality of life during and after treatment while limiting side effects. Quality of life was evaluated in an active study that used endoluminal brachytherapy as a preoperative treatment [5] in these patients. Our case died of necrotizing fasciitis of the perineum, which is a rare disease with a high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

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High-dose rate brachytherapy for palliative care in rectal cancer: A case with a complete response, followed by a rare complication

Aurélia¹,

Léobon²,

Clavère³

2019

Gastroenterol Hepatol Endosc

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Purpose: There are no guidelines for palliative care to relieve patients from pain, bleeding and obstruction due to locally advanced rectal tumours. These patients are fragile, with comorbidities, and have been previously treated by external-beam radiotherapy. Brachytherapy with iridium-192 (interstitial or endoluminal) delivers a high dose of radiation to the tumour, while preserving the surrounding tissues. This technique achieves effective palliation in many cancers; it is also used worldwide for recurrent or inoperable rectal tumours. We report a patient diagnosed with inoperable rectal adenocarcinoma. He had received endorectal high-dose rate brachytherapy to reduce rectal bleeding and pelvic pain. Nevertheless, he presented a rare complication after brachytherapy. Method:We selected a patient who had been treated with endorectal high-dose brachytherapy at the Limoges University Hospital Centre. His medical records were analysed retrospectively. The patient had severe cardiovascular comorbidities and had previously received pelvic external-beam radiotherapy. High-dose rate brachytherapy was delivered with an endoluminal vaginal/rectal cylinder applicator connected to an iridium-192 stepping source. A single dose of 5 Gy, weekly, was applied. The aim was to improve his quality of life by relieving him of bleeding and pain.Results: High-dose rate brachytherapy was immediately well tolerated. Moreover, there was no problem of compliance because of the short duration of treatment, which was easily performed. The patient described an overall complete response to his symptoms after 1 month. The bleeding stopped and he was withdrawn from opioids. He regained his quality of life and maintained independence at home. Nevertheless, he died 2 months after the end of the treatment of necrotizing fasciitis of the perineum. Conclusion:Intraluminal high-dose rate brachytherapy is a very effective palliative treatment after external-beam radiotherapy. This technique can be easily performed to reduce bleeding, pain and obstruction with significant improvement in patient quality of life. However, precautions must be taken for patients with severe peripheral arterial disease who have previously received external-beam radiotherapy.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

High-dose rate brachytherapy for palliative care in rectal cancer: A case with a complete response, followed by a rare complication

Aurélia¹,

Léobon²,

Clavère³

2019

Gastroenterol Hepatol Endosc

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Fournier's gangrene and rectal cancer

Mora-Guzmán,

de Pedro Conal

2024

Rev Esp Enferm Dig

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Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options

Bruketa

Majerović

Augustin

2015

WJG

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Fournier's gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects.

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Necrotising fasciitis secondary to locally advanced rectal cancer

Cited by 3 publications

References 4 publications

High-dose rate brachytherapy for palliative care in rectal cancer: A case with a complete response, followed by a rare complication

High-dose rate brachytherapy for palliative care in rectal cancer: A case with a complete response, followed by a rare complication

Fournier's gangrene and rectal cancer

Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options

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