The use of hyperbaric oxygen to treat actinic rectal fistula after SpaceOAR use and radiotherapy for prostate cancer: a
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Open Access
CASE REPORT
The use of hyperbaric oxygen to treat actinic rectal fistula after SpaceOAR use and radiotherapy for prostate cancer: a case report Tairo Kashihara1* , Koji Inaba1, Motokiyo Komiyama2, Hiroki Nakayama1, Kotaro Iijima1, Shie Nishioka1, Hiroyuki Okamoto1, Nao Kikkawa3, Yuko Kubo3, Satoshi Shima1, Satoshi Nakamura1, Ayaka Takahashi1, Kana Takahashi1, Kae Okuma1, Naoya Murakami1, Hiroshi Igaki1, Yuko Nakayama1, Arinobu Fukunaga2, Yoshiyuki Matsui2, Hiroyuki Fujimoto2 and Jun Itami1
Abstract Background: In definitive radiation therapy for prostate cancer, the SpaceOAR® System, a hydrogel spacer, is widely used to decrease the irradiated dose and toxicity of rectum. On the other hand, periprostatic abscesses formation and rectal perforation are known as rare adverse effects of SpaceOAR. Nevertheless, there is a lack of reports clarifying the association between aggravation of abscesses and radiation therapy, and hyperbaric oxygen therapy (HBOT) is effective for a peri-SpaceOAR abscess and rectal perforation. Case presentation: We report a case of a 78-year-old high-risk prostate cancer patient. After SpaceOAR insertion into the correct space, he started to receive external beam radiation therapy (EBRT). He developed a fever, perineal pain and frequent urination after the completion of EBRT, and the magnetic resonance imaging (MRI) revealed a periSpaceOAR abscess. Scheduled brachytherapy was postponed, administration of antibiotics and opioid via intravenous drip was commenced, and transperineal drainage was performed. After the alleviation of the abscess, additional EBRT instead of brachytherapy was performed with MRI-guided radiation therapy (MRgRT). On the last day of the MRgRT, perineal pain reoccurred, and MRI and colonoscopy detected the rectal perforation. He received an intravenous antibiotics drip and HBOT, and fully recovered from the rectal perforation. Conclusions: Our report indicates that EBRT can lead to a severe rectum complication by causing inflammation for patients with a peri-SpaceOAR abscess. Furthermore, HBOT was effective for the peri-SpaceOAR abscess and rectal perforation associated with EBRT. Keywords: Radiotherapy, Hydrogel spacer, Side effects, Hyperbaric oxygen therapy, MR-guided radiation therapy
*Correspondence: [email protected] 1 Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5‑1‑1, Chuo‑ku, Tokyo, Japan Full list of author information is available at the end of the article
Background A hydrogel spacer is used in radiation therapy (RT) for a variety of cancers to decrease the irradiated dose to the organs at risk (OARs) [1–5]. Furthermore, in pelvic radiation therapy, a hydrogel spacer is used to decrease the rectal dose [6–9]. In definitive RT for prostate cancer, The SpaceOAR® System (Boston Scientific, Marlborough,
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or form
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