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Singh R, Jackson PS, Blake M, et al. Minimal Rectal Toxicity in the Setting of Comorbid Crohn's Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer. Cureus. 2017;9(8):e1533doi: 10.7759/cureus.1533.
Singh, R., Jackson, P. S., Blake, M., Cutlip, J., & Sharma, S. (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. https://doi.org/10.7759/cureus.1533
Singh, Raj, et al. "Minimal Rectal Toxicity in the Setting of Comorbid Crohn's Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer." Cureus vol. 9,8 (2017): e1533. doi: https://doi.org/10.7759/cureus.1533
Singh R, Jackson PS, Blake M, Cutlip J, Sharma S. Minimal Rectal Toxicity in the Setting of Comorbid Crohn's Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer. Cureus. 2017 Aug 01;9(8):e1533. doi: 10.7759/cureus.1533. PMID: 28983442; PMCID: PMC5624568.
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Cureus. 2017 Aug 01;9(8):e1533. doi: 10.7759/cureus.1533.

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

Cureus

Raj Singh, Philip S Jackson, Mollie Blake, James Cutlip, Sanjeev Sharma

Affiliations

  1. Department of Radiation Oncology, Joan C. Edwards School of Medicine, Marshall University.
  2. Department of Radiation Oncology, St. Mary's Medical Center.

PMID: 28983442 PMCID: PMC5624568 DOI: 10.7759/cureus.1533

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.

Keywords: crohns disease; hydrogel spacer; inflammatory bowel disease; intensity-modulated radiotherapy (imrt); prostate cancer; radiation therapy; radiation toxicity; volumetric modulated arc therapy (vmat)

Conflict of interest statement

The authors have declared that no competing interests exist.

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