Late rectal complications after prostate brachytherapy for localized prostate cancer

Abstract

This review of the literature on late rectal complications after prostate brachytherapy indicated that it is a highly effective treatment modality for patients with clinically localized prostate cancer but can cause chronic radiation proctitis. The most common manifestation of chronic radiation proctitis was anterior rectal wall bleeding, which often occurred within the first 2 years after brachytherapy. It is interesting to note that the rates of late rectal morbidity appear to have declined over time, which may reflect improvements in implantation techniques and imaging. Rectal biopsy as part of the workup to evaluate rectal bleeding can lead to rectal fistula and the need for colostomy, a rare but major complication. The authors recommend 1) screening colonoscopy before brachytherapy for patients who have not had a screening colonoscopy within the preceding 3 years to rule out colorectal malignancies and, thus, facilitate conservative management should rectal bleeding occur; 2) lifestyle modifications during treatment to limit exposure of the rectum to radiation; and 3) conservative management for rectal bleeding that occurs within 2 years after brachytherapy. Prostate cancer is the leading cause of cancer in men and accounts for approximately 33% of cancer deaths among men in the US.1,2 Management options for organ-confined, low-to intermediate-risk prostate cancer include watchful waiting, radical prostatectomy, external-beam radiation therapy, and prostate brachytherapy with permanent interstitial implants. Recent improvements in radioactive seed implantation techniques have established prostate brachytherapy as a highly effective treatment modality for localized prostate cancer, with long-term local and biochemical control similar to outcomes observed after radical prostatectomy and external-beam radiation therapy. 3,4 Because prostate cancer is diagnosed

Pelvic Catastrophe after Elastic Band Ligation in an Irradiated Rectum

“…Endoscopically, the mucosa is inflamed, friable, and oedematous, and on histopathology only the superficial mucosa is affected [2] . It occurs shortly after treatment and usually resolves within 3-6 months with conservative measures [4] .…”

Histomorphological Processes in the Testicular Tissue at Ionizing Radiation Exposure (Literature Review)

“…Тaк, былo уcтaнoвлeнo, чтo лeчeниe бoль-ных c oпухoлeвыми зaбoлeвaниями пpeдcтaтeльнoй жeлeзы пocpeдcтвoм внeшнeгo paдиoaктивнoгo oблучeния, пpo вoдимoe в мaлых дoзaх в уcлoвиях нeзaщищeнных ceмeнникoв, пpивoдит к бecплoдию и ухудшeнию гopмoнaльнoй функции [46]. Пo дaнным paдиoлoгoв, в peзультaтe пpoвeдeния лучeвoй тepaпии c тeчeниeм вpeмeни нapacтaют явлeния нapушeния микpoциpкуляции в oблучённoм opгaнe, чтo пpивoдит к вoзникнoвeнию тpoмбoзoв мeлких cocудoв, ишeмии ткaнeй, эpoзиям и oбpaзoвaнию лучeвых язв [38]. Типичным пpoявлeниeм пoздних лучeвых пoвpeждeний являeтcя paдиaциoннo-ин-дуциpoвaнный фибpoз, пpoгpeccиpoвaниe кoтopoгo знaчитeльнo oтягoщaeт кли-ничecкую кapтину [10].…”

“…Типичным пpoявлeниeм пoздних лучeвых пoвpeждeний являeтcя paдиaциoннo-ин-дуциpoвaнный фибpoз, пpoгpeccиpoвaниe кoтopoгo знaчитeльнo oтягoщaeт кли-ничecкую кapтину [10]. Из литepaтуpы извecтнo, чтo пpичины paзвития лучeвых пoвpeждeний, в чacтнocти, oбуcлoвлeны oшибкaми пpи плaниpoвaнии и пpoвeдeнии paдиoтepaпии, кoгдa пpимeняютcя выcoкиe paзoвыe и cуммapныe дoзы, пpeвышaющиe тoлepaнтнocть здopoвых ткaнeй к иoни-зиpующeму излучeнию [38].…”

Behandlung enterovesikaler Fisteln beim Mann

“…Die Radiotherapie eines lokalen Prostata karzinomrezidivs stellt eine häufige Ursa che für die Entwicklung enterovesikaler Fisteln dar [6,7,8,9,10,11]. Trotz geringer Inzidenz präsentiert sich diese Erkran kung mit einer hohen Morbidität.…”