The use of hyperbaric oxygen to treat actinic rectal fistula after SpaceOAR use and radiotherapy for prostate cancer: a case report

Abstract

Background In definitive radiation therapy for prostate cancer, the SpaceOAR® System, a hydrogel spacer, is widely used to decrease the irradiated dose and toxicity of rectum. On the other hand, periprostatic abscesses formation and rectal perforation are known as rare adverse effects of SpaceOAR. Nevertheless, there is a lack of reports clarifying the association between aggravation of abscesses and radiation therapy, and hyperbaric oxygen therapy (HBOT) is effective for a peri-SpaceOAR abscess and rectal perforation. Case presentation We report a case of a 78-year-old high-risk prostate cancer patient. After SpaceOAR insertion into the correct space, he started to receive external beam radiation therapy (EBRT). He developed a fever, perineal pain and frequent urination after the completion of EBRT, and the magnetic resonance imaging (MRI) revealed a peri-SpaceOAR abscess. Scheduled brachytherapy was postponed, administration of antibiotics and opioid via intravenous drip was commenced, and transperineal drainage was performed. After the alleviation of the abscess, additional EBRT instead of brachytherapy was performed with MRI-guided radiation therapy (MRgRT). On the last day of the MRgRT, perineal pain reoccurred, and MRI and colonoscopy detected the rectal perforation. He received an intravenous antibiotics drip and HBOT, and fully recovered from the rectal perforation. Conclusions Our report indicates that EBRT can lead to a severe rectum complication by causing inflammation for patients with a peri-SpaceOAR abscess. Furthermore, HBOT was effective for the peri-SpaceOAR abscess and rectal perforation associated with EBRT.

Seed lost to perineum from hydrogel spacer after brachytherapy for prostate cancer

“…On the subject of remission with conservative treatment, there are reports of spontaneous remission with low‐fiber diet for rectal ulcer, remission of perineal abscess after administration of antibiotics and drainage 3 ; and remission due to administration of antibiotics and hyperbaric oxygen for rectal perforation. 5 In this case, no rectal ulcer, abscess, or rectourethral fistula was observed, and spontaneous remission was observed following conservative treatment with antibiotics and drainage. However, in patients with delayed wound healing and a high risk of infection, appropriate diagnosis and treatment along with careful follow‐up, are important in the perioperative period and beyond.…”

“…Various reports have shown adverse events related to hydrogel injection. On the subject of remission with conservative treatment, there are reports of spontaneous remission with low‐fiber diet for rectal ulcer, remission of perineal abscess after administration of antibiotics and drainage 3 ; and remission due to administration of antibiotics and hyperbaric oxygen for rectal perforation 5 . In this case, no rectal ulcer, abscess, or rectourethral fistula was observed, and spontaneous remission was observed following conservative treatment with antibiotics and drainage.…”

“…2 Additionally, Vagger et al reported proctitis, rectal bleeding and ulcers, rectourethral fistulas, and anaphylactic shock as complications associated with hydrogel injection. 3 There have also been reports of perineal abscesses 4 and rectal perforation 5,6 as serious complications; however, seed loss from the perineum has not been previously reported. In this case, retrospective imaging studies led us to believe that a seed placed near the coating on the right side of the dorsal prostatic margin had fallen out of the perineum.…”

Bladder stone formation around polyethylene glycol after use of SpaceOAR Hydrogel

“…Some reports have described adverse events associated with the use of SpaceOAR ® Hydrogel. Most have been written about the rectum and the prostate, such as proctitis, rectourethral fistula, prostatic abscess, etc 2–4 . As far as we investigated, there has been no report about the bladder stone.…”

“…However, some reports of complications associated with the use of the SpaceOAR ® Hydrogel have arisen 2–4 . Aminsharifi et al .…”