Rectal spacer placement for anorectal reirradiation of de novo rectal or anal cancer following prostate radiation therapy Journal Article
| Authors: | Dreyfuss, A. D.; Navilio, J. P.; Kim, N.; Shim, A.; Romesser, P. B.; Reyngold, M.; Zelefsky, M. J.; Crane, C. H.; Hajj, C. |
| Article Title: | Rectal spacer placement for anorectal reirradiation of de novo rectal or anal cancer following prostate radiation therapy |
| Abstract: | Simple Summary: Pelvic reirradiation of de novo rectal or anal cancer after prior prostate cancer radiation carries several risks, including urinary and rectal fistula. Because of this, radiation is often omitted in these patients despite being an important component of standard of care therapy, leading to compromised outcomes and inferior quality of life. We therefore aimed to implement and evaluate the safety and feasibility of a novel approach to pelvic reirradiation of de novo rectal or anal cancer after prior prostate radiation, involving the placement of a rectal spacer prior to intensity-modulated radiation therapy or proton beam therapy. In this case series, we demonstrated excellent dosimetry and minimal toxicity with this approach, offering a feasible, promising treatment approach that can optimize patient outcomes, preserve quality of life, and maintain radiation therapy as a treatment option in patients with a history of prior pelvic radiation. Background: Pelvic reirradiation of de novo rectal or anal cancer after prior prostate cancer RT poses a significant risk of urinary and rectal fistula. In this report we describe the use of a rectal spacer to improve dosimetry and reduce this risk. Methods: Patients undergoing anorectal radiotherapy (RT) after prior prostate RT who had a rectal spacer placed prior to RT were identified in a prospective database. Patient, disease, and treatment characteristics were collected for these patients. Survival data were calculated from the end of RT. Radiation was delivered with intensity-modulated radiation therapy (IMRT) or proton beam therapy (PBT) following rectal spacer placement. Results: Rectal spacer placement with hydrogel injected transperineally under transrectal ultrasound guidance was successful in all five patients. MR/CT simulation 1–2 weeks post-spacer placement and IMRT or PBT delivered to a dose of 36–50 Gy in 24–30 fractions once or twice daily were tolerated well by all patients. The V100% of the PTV ranged from 62–100% and mean rectal and bladder dose ranged from 39–46 Gy and 16–40 Gy, respectively. At the last follow-up, three patients were alive and without evidence of disease up to 48 months out from treatment. There were no acute or late grade 3 or higher toxicities observed, but acute grade 2 proctitis was observed in all patients. Conclusions: The use of a rectal spacer placement to improve dosimetry of IMRT and PBT after prior prostate RT is safe and feasible in appropriately selected anorectal cancer patients. |
| Keywords: | aged; survival analysis; carcinoma, squamous cell; treatment duration; united states; lymph nodes; prospective studies; quality of life; risk assessment; dosimetry; colonoscopy; pelvic neoplasms; neoplasm metastasis; neoplasm invasiveness; chemoradiotherapy; digital rectal examination; descriptive statistics; outpatients; cancer patients; carboplatin -- therapeutic use; rectal diseases; radiation injuries -- prevention and control; radiotherapy, conformal -- adverse effects; neoplasm recurrence, local -- radiotherapy; prostatic neoplasms -- radiotherapy; rectal neoplasms -- radiotherapy; adenocarcinoma -- radiotherapy; paclitaxel -- therapeutic use; patient safety -- evaluation; anus neoplasms -- diagnosis; human; male; positron emission tomography computed tomography; capecitabine -- therapeutic use; anus neoplasms -- radiotherapy; pelvic neoplasms -- radiotherapy; proton therapy -- adverse effects; gels -- therapeutic use; pelvic neoplasms -- ultrasonography |
| Journal Title: | Radiation |
| Volume: | 4 |
| Issue: | 3 |
| ISSN: | 2673-592X |
| Publisher: | MDPI |
| Date Published: | 2024-09-01 |
| Start Page: | 242 |
| End Page: | 252 |
| Language: | English |
| DOI: | 10.3390/radiation4030019 |
| PROVIDER: | EBSCOhost |
| PROVIDER: | cinahl plus with full text |
| DOI/URL: | |
| Notes: | Source: CINAHL Plus with Full Text |
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