High-dose-rate brachytherapy for prostate cancer in a previously radiated patient with polyethylene glycol hydrogel spacing to reduce rectal dose: Case report and review of the literature

摘要: Abstract Purpose To describe the use of a temporary spacer to reduce rectal dose prior prostate radiation in man with pelvic radiotherapy and review relevant literature. Methods Materials A healthy 57-year-old presented high-risk cancer (Gleason score 8, prostate-specific antigen level [PSA] 12.6 ng/mL, T3a by magnetic resonance imaging [MRI]), only 2.5 years after low anterior resection followed chemo-radiotherapy 50.4 Gy for locally advanced cancer. Due radiation, he was not felt be candidate surgery or external beam so chose long-term androgen deprivation therapy (ADT) plus high-dose-rate brachytherapy 36 6 fractions. wall, 10 mL polyethylene glycol hydrogel injected between rectum created 1.4 1.5 cm separation along length prostate. Results Two randomized trials demonstrating that local ADT improves overall survival compared alone provided rationale additional this otherwise patient. Salvage is associated 3.4% rate fistula among 251 cases reported literature from 2000–2007, rates as high 12% one series. The allowed constraint goals easily met. Conclusions Injecting an absorbable separate appears decreased maximum mean doses, may have particular utility previously irradiated patients.