Safety and efficacy of iodine-125 permanent prostate brachytherapy in patients with J-pouch anastomosis after total colectomy for ulcerative colitis

Cherian, Sheen; Kittel, J. A.; Reddy, Chandana A.; Kolar, M.; Ulchaker, James; Angermeier, Kenneth W.; Stephans, Kevin L.; Tendulkar, Rahul D.; Klein, Eric A.; Ciezki, Jay P.

doi:10.1016/j.prro.2015.03.002

Cited by 15 publications

(6 citation statements)

References 19 publications

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“…Of the 6 patients in our series with stage II or III ASCC, all received standard treatment protocols with EBRT and 5-fluorouracil and mitomycin chemotherapy regimens. 10,11 Consistent with the poor functional outcomes of EBRT on IPAA in the literature regarding IPAA and radiation therapy for prostate adenocarcinoma, [12][13][14][15] all 4 patients with an IPAA in situ in our series required intestinal diversion or pouch excision due to their inability to tolerate their treatment protocol. Similarly, just as EBRT is a relative contraindication to pouch formation following EBRT because of the potential for compromised pouch function in the setting of a prior EBRT, the 2 patients in our series without a pouch in situ never underwent an IPAA after their ASCC treatment.…”

Section: Discussionsupporting

confidence: 75%

“…8,9 However, in the setting ASCC, where standard of care includes external beam radiation therapy (EBRT), 10,11 EBRT may preclude pouch construction at a later date or may not be tolerated by patients with an IPAA in situ. [12][13][14][15] First, we herein report the results of a single institution's incidence of low-and high-grade squamous intraepithelial lesions (LSIL/HSIL) and ASCC for all adult patients with UC evaluated at our institution. Second, we report the patient characteristics, UC disease characteristics, HPV association, and treatment outcomes of all patients with UC diagnosed with anal neoplasia at a single institution to better understand treatment practices for this particular patient population with and without IPAA.…”

Section: Limitacionesmentioning

confidence: 99%

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Anal Squamous Cell Carcinoma in Ulcerative Colitis: Can Pouches Withstand Traditional Treatment Protocols?

Lightner

Vaidya

McMichael

et al. 2021

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Anal squamous cell carcinoma has rarely been reported in the setting of ulcerative colitis. OBJECTIVE: This study aimed to understand the prognosis of anal squamous cell carcinoma in the setting of ulcerative colitis. DESIGN: This is a retrospective review. SETTING: This study was conducted at a referral center. PATIENTS: Adult patients with both ulcerative colitis (556.9/K51.9) and anal squamous cell carcinoma (154.3/C44.520) between January 1, 2000 and August 1, 2019 were included. MAIN OUTCOMES MEASURES: The primary outcomes measured are treatment and survival of anal squamous cell carcinoma. RESULTS: Of the 13,499 patients with ulcerative colitis treated, 17 adult patients with ulcerative colitis and anal dysplasia and/or anal squamous cell carcinoma were included in the study: 6 had a diagnosis of anal squamous cell carcinoma, 8 had high-grade squamous intraepithelial lesions, and 3 had low-grade squamous intraepithelial lesions. There were 4 men (23%) and a median age of 55 years (range, 32–69) years. At diagnosis, 6 had an IPAA, of which 5 had active pouchitis, 1 had an ileorectal anastomosis with active proctitis, 1 had a Hartmann stump with disuse proctitis, 5 had pancolitis, and 4 had left-sided colitis. Of the 6 with anal squamous cell carcinoma, all received 5-fluorouracil and mitomycin C with external beam radiation therapy. Four patients had an IPAA, all of whom required intestinal diversion or pouch excision because of treatment intolerance. At a median follow-up of 60 months, 3 patients died: one at 0 months (treatment-related myocardial infarction), one at 60 months (metastatic anal squamous cell carcinoma), and one at 129 months (malignant peripheral nerve sheath tumor); the remaining patients had no residual disease. LIMITATIONS: This study was limited because of its retrospective nature and small number of patients. CONCLUSION: Anal squamous cell carcinoma in the setting of ulcerative colitis is extremely rare. In the setting of IPAA, diversion may be necessary to prevent radiation intolerance. Careful examination of the perianal region should be performed at the time of surveillance endoscopy. See Video Abstract at http://links.lww.com/DCR/B582. CARCINOMA ANAL DE CÉLULAS ESCAMOSAS EN COLITIS ULCEROSA: ¿PUEDE EL POUCH MODIFICAR LOS RESULTADOS DE LOS PROTOCOLOS DE TRATAMIENTO TRADICIONAL ANTECEDENTES: La incidencia de cáncer anal de células escamosas es muy baja en pacientes con colitis ulcerosa. OBJETIVO: Comprender el pronóstico del cáncer anal de células escamosas en el contexto de la colitis ulcerosa. DISEÑO: Revisión retrospectiva. AJUSTE: Centro de referencia. PACIENTES: Pacientes adultos con colitis ulcerosa (556.9 / K51.9) y cáncer anal de células escamosas (154.3 / C44.520) entre el 1 de enero de 2000 y el 1 de agosto de 2019. RESULTADOS PRINCIPALES: Tratamiento y sobrevida del cáncer anal de células escamosas. RESULTADOS: De 13.499 pacientes en tratamiento por colitis ulcerosa, diecisiete presentaron displasia y/o cáncer de células escamosas: 6 con cáncer, 8 con lesiones intraepiteliales escamosas con displasia de alto grado y 3 con displasia de bajo grado. Cuatro son hombres (23 %) con una mediana de 55 años (rango 32-69). Al realizar el diagnóstico 6 tenían pouch, 5 con pouchitis activa; 1 con ileorecto anastomosis con proctitis activa y 1 con operación de Hartman y muñón con colitis por desuso; además 5 tenían pancolitis y 4 tenían colitis izquierda Todos los casos con cáncer anal de células escamosas (6 pacientes), fueron tratados con 5-FU mas Mitomicina y radioterapia externa. Cuatro pacientes tenían pouch, todos requirieron derivación intestinal o escisión del pouch por intolerancia al tratamiento. En la mediana de seguimiento de 60 meses, tres pacientes fallecieron: uno a los 0 meses (infarto de miocardio relacionado con el tratamiento), uno a los 60 meses (cáncer de células escamosas metastásico) y uno a los 129 meses (tumor maligno de la vaina del nervio periférico); el resto no presentaba enfermedad residual. LIMITACIONES: Revisión retrospectiva, número pequeño de pacientes. CONCLUSIÓN: El cáncer anal de células escamosas en el contexto de la colitis ulcerosa es extremadamente raro. En el contexto de IPAA, la derivación puede ser necesaria para prevenir la intolerancia a la radiación. Se debe realizar un examen cuidadoso de la región perianal en el momento de la endoscopia de control. Consulte Video Resumen en http://links.lww.com/DCR/B582.

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Section: Discussionsupporting

confidence: 75%

Section: Limitacionesmentioning

confidence: 99%

Anal Squamous Cell Carcinoma in Ulcerative Colitis: Can Pouches Withstand Traditional Treatment Protocols?

Lightner

Vaidya

McMichael

et al. 2021

Diseases of the Colon &Amp; Rectum

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“…While there are now several reports indicating that postoperative EBRT results in increased complications and impaired bowel function following a low rectal anastomosis , there are limited data regarding the effect on IPAA function. Most of the available literature includes outcomes following interstitial brachytherapy for prostate cancer, as opposed to pelvic EBRT used for colorectal malignancy . One report of seven patients undergoing permanent prostate brachytherapy found that patients had equivalent functional outcomes following brachytherapy therapy for prostate cancer, except for an increased rate of pouchitis .…”

Section: Discussionmentioning

confidence: 99%

“…Most of the available literature includes outcomes following interstitial brachytherapy for prostate cancer, as opposed to pelvic EBRT used for colorectal malignancy . One report of seven patients undergoing permanent prostate brachytherapy found that patients had equivalent functional outcomes following brachytherapy therapy for prostate cancer, except for an increased rate of pouchitis . Similarly, another report of five pouch patients who received brachytherapy for prostate cancer found that pouch function worsened during therapy but returned to baseline within 4 months of completing brachytherapy .…”

Section: Discussionmentioning

confidence: 99%

Does external beam radiation therapy to the pelvis portend worse ileal pouch outcomes? An international multi‐institution collaborative study

et al. 2018

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Aim Short‐term morbidity and long‐term functional outcome of patients with an ileal pouch‐anal anastomosis (IPAA) exposed to pelvic external beam radiation therapy (EBRT) remains unknown. We report the largest series to date regarding the effects of pelvic EBRT on: (i) 30‐day postoperative outcomes; and (ii) long‐term functional outcome following IPAA. Method A retrospective chart review was conducted of patients who received EBRT before or after IPAA between 1980 and 2017 across three international inflammatory bowel disease referral centres. Results Nineteen patients were included. Indications for EBRT were rectal adenocarcinoma (n = 13), prostate adenocarcinoma (n = 4) or anal squamous cell carcinoma (ASCC) (n = 2). EBRT was given prior to IPAA in 12 (63%) patients and after IPAA in seven (37%). In EBRT before IPAA, patients had a median of 5 (range: 4–8) daytime bowel movements, 1 (range: 0–5) night‐time bowel movement, no daytime incontinence, and only one patient used pads at a median follow up of 25 (range: 11–163) months; one patient underwent pouch excision 15 months after IPAA. In EBRT after IPAA, patients reported a median of 8 (range: 5–10) daytime and 2 (range: 0–5) night‐time bowel movements, 80% had either daytime or night‐time incontinence and 80% used pads at a median follow up of 90 (range: 25–315) months. Conclusion Pelvic EBRT administered prior to IPAA is associated with acceptable long‐term function outcome. However, when pelvic EBRT is given to an IPAA in situ, most patients experience poor long‐term pouch function without pouch failure.

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“…Interestingly, a recent retrospective study showed that permanent prostate brachytherapy could be a better option in IPAA patients. 9 The permanent prostate brachytherapy would protect the pouch from excessive radiation by using the mesenteric pad as an “anatomical buffer zone” in between the anterior pouch wall and the prostate. 9 …”

Section: Discussionmentioning

confidence: 99%

Pouchitis Associated With Pelvic Radiation for Prostate Cancer

Kulkarni¹,

Liu²,

Shen³

2016

ACG Case Reports Journal

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Radiation therapy is a viable option in managing potentially life-threatening malignancies including prostate cancer. It is known that pelvic radiation can result in injury of the distal large bowel with the development of radiation proctitis. Despite reports from retrospective studies, there is a lack of direct endoscopic and histologic evidence of external pelvic radiation injury to the ileal pouch-anal anastomosis. We present a case of a 68-year-old male with pouchitis resulting from pelvic radiation for prostate cancer.

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Safety and efficacy of iodine-125 permanent prostate brachytherapy in patients with J-pouch anastomosis after total colectomy for ulcerative colitis

Cited by 15 publications

References 19 publications

Anal Squamous Cell Carcinoma in Ulcerative Colitis: Can Pouches Withstand Traditional Treatment Protocols?

Anal Squamous Cell Carcinoma in Ulcerative Colitis: Can Pouches Withstand Traditional Treatment Protocols?

Does external beam radiation therapy to the pelvis portend worse ileal pouch outcomes? An international multi‐institution collaborative study

Pouchitis Associated With Pelvic Radiation for Prostate Cancer

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