Interstitial hydrogel provides both rectal immobilization and spacing between the prostate and rectum during prostate radiotherapy and reduces the incidence and severity of rectal toxicity. Its use during prostate proton therapy has not yet been evaluated. Materials/Methods: Patients with localized prostate cancer were treated with definitive proton beam therapy at a single institution on a multiinstitutional registry protocol (PCG GU-002). Patients were treated to a dose of 79.2 Gy(RBE) in 44 fractions (762 patients), 70 Gy(RBE) in 28 fractions (102 patients) or 38 Gy(RBE) in 5 fractions (51 patients). Patients were treated in consecutive cohorts with rectal water (RW), rectal balloon (RB) or hydrogel spacer (HS), and followed prospectively for late (>90 days after treatment) adverse events. Toxicity was assessed using CTCAE version 4.0 and compared between cohorts using pairwise chi-square tests. Results: 947 patients treated from 10/10 through 2/17, with median follow-up of 4.4 years and minimum follow-up of 1.5 years. RW was used in 385 patients, RB in 342 patients, and HS in 220 patients. Grade3 toxicity did not occur in the HS cohort and was rare in the RW and RB cohorts (<1%). Grade2 overall GI toxicity rates were lower for HS (2.2%) relative to RW (14.8%, p<0.001) and RB (17.3%, p<0.001). Grade 2 rectal bleeding was lower for HS (2.2%) relative to RW (10.4%, p<0.001) and RB (12.3%, p<0.001). Conclusion: Interstitial hydrogel spacer during proton therapy reduces the risk of gastrointestinal toxicities and rectal bleeding.
Latent autoimmune diabetes of adults (LADA) is a type of autoimmune diabetes that begins in adulthood (usually after the age of 35 years); its main feature is the presence of diabetes-associated autoantibodies (most often autoantibody against glutamic acid decarboxylase), which leads to progressive destruction of the islets of Langerhans. This is a heterogeneous condition that presents with clinical and laboratory manifestations common to type 1 diabetes and type 2 diabetes.We report a case of a 71-year-old man diagnosed with type 2 diabetes two years ago, poorly controlled with oral antidiabetic therapy, and worsening in the third year. He had a positive family history of type 2 diabetes in two second-degree relatives (nephews). No pathologic findings at the physical examination were found.His body mass index was 23 kg/m 2 and glycated hemoglobin was 10.6%. Laboratory workup revealed low basal C-peptide (<0.1 ng/mL) and positive glutamic acid decarboxylase antibodies, and the LADA diagnosis was confirmed. This case highlights the importance of being aware of this disease, especially in patients previously diagnosed with type 2 diabetes who remain uncontrolled with diet and oral hypoglycemic agents. LADA is often confused with type 2 diabetes, and therefore, the management is frequently inadequate. An early diagnosis and treatment are crucial to delaying disease progression.
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