RESUMO
PURPOSE: To assess the effect of a shrinking rectal balloon implant (RBI) on the anorectal dose and complication risk during the course of moderately hypofractionated prostate radiotherapy. METHODS: In 15 patients with localized prostate cancer, an RBI was implanted. A weekly kilovolt cone-beam computed tomography (CBCT) scan was acquired to measure the dynamics of RBI volume and prostate-rectum separation. The absolute anorectal volume encompassed by the 2 Gy equieffective 75 Gy isodose (V75Gy) was recalculated as well as the mean anorectal dose. The increase in estimated risk of grade 2-3 late rectal bleeding (LRB) between the start and end of treatment was predicted using nomograms. The observed acute and late toxicities were evaluated. RESULTS: A significant shrinkage of RBI volumes was observed, with an average volume of 70.4% of baseline at the end of the treatment. Although the prostate-rectum separation significantly decreased over time, it remained at least 1 cm. No significant increase in V75Gy of the anorectum was observed, except in one patient whose RBI had completely deflated in the third week of treatment. No correlation between mean anorectal dose and balloon deflation was found. The increase in predicted LRB risk was not significant, except in the one patient whose RBI completely deflated. The observed toxicities confirmed these findings. CONCLUSIONS: Despite significant decrease in RBI volume the high-dose rectal volume and the predicted LRB risk were unaffected due to a persistent spacing between the prostate and the anterior rectal wall.
Assuntos
Adenocarcinoma/radioterapia , Canal Anal/efeitos da radiação , Neoplasias da Próstata/radioterapia , Doses de Radiação , Hipofracionamento da Dose de Radiação , Lesões por Radiação/prevenção & controle , Reto/efeitos da radiação , Adenocarcinoma/diagnóstico por imagem , Idoso , Canal Anal/diagnóstico por imagem , Desenho de Equipamento , Falha de Equipamento , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/efeitos da radiação , Neoplasias da Próstata/diagnóstico por imagem , Próteses e Implantes , Lesões por Radiação/diagnóstico por imagem , Doenças Retais/diagnóstico por imagem , Doenças Retais/prevenção & controle , Reto/diagnóstico por imagem , Medição de RiscoRESUMO
We present a case of a male kidney transplant patient harbouring two kidney grafts of which one is functional. In the failed graft, he developed urothelial cell carcinoma with cells containing XX-chromosome, and female tumour cells were also found in the bladder. The patient underwent donor nephrectomy, was treated with epirubicin bladder instillations, and immunosuppression was tapered. Less than a year before re-transplantation a CT scan showed no abnormalities of the first graft. Transplantectomy before a second kidney transplantation is debated.