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Case report
peer-reviewed

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



Abstract

We present one of the first cases of a prostate cancer (PCa) patient with inflammatory bowel disease (IBD) treated with intensity-modulated radiotherapy (IMRT) and a hydrogel rectal spacer. A 73-year-old male with a past medical history significant for Crohn’s disease (CD) and the recent diagnosis of T1cN0M0 high-risk PCa was referred for definitive radiotherapy. Given the patient’s history of CD and the possible increased risk of gastrointestinal (GI) toxicity and disease exacerbation, prior to IMRT, a hydrogel spacer was placed between the prostate and the anterior rectal wall to further minimize irradiation to the rectum. The patient then received IMRT (78 Gy/2 Gy fractions at a 100 percent isodose line). Over the course of treatment, Radiation Therapy Oncology Group (RTOG) Grade 1 GI toxicities of mild diarrhea were noted during the fifth and sixth weeks of treatment as well as an RTOG Grade 1 genitourinary (GU) toxicity of a decrease in the urinary stream that resolved with tamsulosin. At the 3, 6, 9, and 12-month follow-ups, bowel movements and urinary stream were reported to be at baseline with prostate-specific antigen (PSA) levels of 0.18 ng/mL and 0.03 ng/mL at the three and nine-month follow-ups, respectively. As such, this case report suggests that IBD patients with localized PCa may be viable candidates for radiotherapy given the promising results of hydrogel spacers in combination with IMRT in limiting rectal toxicity.



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Case report
peer-reviewed

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


Author Information

Raj Singh Corresponding Author

Department of Radiation Oncology, Joan C. Edwards School of Medicine, Marshall University

Philip S. Jackson

Department of Radiation Oncology, St. Mary's Medical Center

Mollie Blake

Department of Radiation Oncology, St. Mary's Medical Center

James Cutlip

Department of Radiation Oncology, St. Mary's Medical Center

Sanjeev Sharma

Department of Radiation Oncology, St. Mary's Medical Center


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

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


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Case report
peer-reviewed

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

  • Author Information
    Raj Singh Corresponding Author

    Department of Radiation Oncology, Joan C. Edwards School of Medicine, Marshall University

    Philip S. Jackson

    Department of Radiation Oncology, St. Mary's Medical Center

    Mollie Blake

    Department of Radiation Oncology, St. Mary's Medical Center

    James Cutlip

    Department of Radiation Oncology, St. Mary's Medical Center

    Sanjeev Sharma

    Department of Radiation Oncology, St. Mary's Medical Center


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: August 01, 2017

    DOI

    10.7759/cureus.1533

    Cite this article as:

    Singh R, Jackson P S, Blake M, et al. (August 01, 2017) Minimal Rectal Toxicity in the Setting of Comorbid Crohn’s Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer. Cureus 9(8): e1533. doi:10.7759/cureus.1533

    Publication history

    Received by Cureus: June 29, 2017
    Peer review began: July 11, 2017
    Peer review concluded: July 31, 2017
    Published: August 01, 2017

    Copyright

    © Copyright 2017
    Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

We present one of the first cases of a prostate cancer (PCa) patient with inflammatory bowel disease (IBD) treated with intensity-modulated radiotherapy (IMRT) and a hydrogel rectal spacer. A 73-year-old male with a past medical history significant for Crohn’s disease (CD) and the recent diagnosis of T1cN0M0 high-risk PCa was referred for definitive radiotherapy. Given the patient’s history of CD and the possible increased risk of gastrointestinal (GI) toxicity and disease exacerbation, prior to IMRT, a hydrogel spacer was placed between the prostate and the anterior rectal wall to further minimize irradiation to the rectum. The patient then received IMRT (78 Gy/2 Gy fractions at a 100 percent isodose line). Over the course of treatment, Radiation Therapy Oncology Group (RTOG) Grade 1 GI toxicities of mild diarrhea were noted during the fifth and sixth weeks of treatment as well as an RTOG Grade 1 genitourinary (GU) toxicity of a decrease in the urinary stream that resolved with tamsulosin. At the 3, 6, 9, and 12-month follow-ups, bowel movements and urinary stream were reported to be at baseline with prostate-specific antigen (PSA) levels of 0.18 ng/mL and 0.03 ng/mL at the three and nine-month follow-ups, respectively. As such, this case report suggests that IBD patients with localized PCa may be viable candidates for radiotherapy given the promising results of hydrogel spacers in combination with IMRT in limiting rectal toxicity.



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Raj Singh, Medical Student

Department of Radiation Oncology, Joan C. Edwards School of Medicine, Marshall University

For correspondence:
singh19@marshall.edu

Philip S. Jackson

Department of Radiation Oncology, St. Mary's Medical Center

Mollie Blake

Department of Radiation Oncology, St. Mary's Medical Center

James Cutlip

Department of Radiation Oncology, St. Mary's Medical Center

Sanjeev Sharma

Department of Radiation Oncology, St. Mary's Medical Center

Raj Singh, Medical Student

Department of Radiation Oncology, Joan C. Edwards School of Medicine, Marshall University

For correspondence:
singh19@marshall.edu

Philip S. Jackson

Department of Radiation Oncology, St. Mary's Medical Center

Mollie Blake

Department of Radiation Oncology, St. Mary's Medical Center

James Cutlip

Department of Radiation Oncology, St. Mary's Medical Center

Sanjeev Sharma

Department of Radiation Oncology, St. Mary's Medical Center