Is prostate cancer radiotherapy using implantable rectum spacers safe and effective in inflammatory bowel disease patients?. (March 2021)

• Record Type: Journal Article
• Authors: Vanneste, Ben G.L.; Van Limbergen, Evert J.; Marcelissen, Tom; Reynders, Kobe; Melenhorst, Jarno; van Roermund, Joep G.H.; Lutgens, Ludy
• Is Part Of: Clinical and translational radiation oncology. Volume 27(2021)
• Page Start: 121
• Page End: 125
• Publication Date: 2021-03
• Subjects: Prostate cancer -- Radiotherapy -- Rectum balloon implant -- Inflammatory bowel disease; Cancer -- Radiotherapy -- Periodicals; Oncology -- Periodicals; Cancer -- Radiotherapy; Oncology; Radiation Oncology; Neoplasms -- radiotherapy; Translational Medical Research; Periodicals; Electronic journals; Periodicals; 616.9940642
• DOI: 10.1016/j.ctro.2021.01.007
• Languages: English
• ISSNs: 2405-6308

Abstract

Highlights: Radiotherapy in patients with inflammatory bowel disease remains controversial. A biodegradable balloon is inserted between the prostate and the rectal wall. The balloon pushes the anterior rectal wall outside of the high-dose area. No grade 3 or more rectal toxicities were observed. Abstract: Background: Prostate cancer radiotherapy (RT) in patients with (active) inflammatory bowel disease (IBD) remains controversial. We hypothesized that RT in combination with a biodegradable prostate-rectum spacer balloon implantation, might be a safe treatment approach with acceptable toxicities for these high risk for rectal toxicity patients. Materials and methods: We report on a small prospective mono-centric series of 8 patients with all-risk prostate cancer with the comorbidity of an IBD. Four patients had Crohn's disease and 4 patients had ulcerative colitis. One out of four had an active status of IBD. All patients were intended to be treated with curative high-dose RT: 5 patients were treated with external beam RT (70 Gray (Gy) in 28 fractions), and 3 patients were treated with 125 I-implant (145 Gy). Toxicities were scored according to the CTCAE v4.03: acute side effects occur up to 3 months after RT, and late side effects start after 3 months. Results: Median follow-up was 13 months (range: 3–42 months). Only one acute grade 2 gastro-intestinal (GI) toxicity was observed: an increased diarrhea (4–6 above baseline) during RT, which resolved completely 6 weeks after treatment. No late grade 3 or more GI toxicity was reported, and no acute and late grade ≥2 genitourinary toxicity events were observed. Conclusion: Prostate cancer patients with IBD are a challenge to treat with RT. Our results suggest that RT in combination with a balloon implant in selective patients with (active) IBD may be promising, however additional validation is needed.