Rectal fistulae after salvage high-intensity focused ultrasound for recurrent prostate cancer after combined brachytherapy and external beam radiotherapy.
OBJECTIVE
To report on the high rectal fistula rate associated with salvage high-intensity focused ultrasound (HIFU) after the failure of combined brachytherapy and external beam radiotherapy (EBRT) for prostate cancer; salvage ablative therapy for prostate cancer is indicated when there is local recurrence after RT, brachytherapy or their combination.


METHODS
We retrospectively reviewed all men with prostate cancer treated with HIFU between 1 March 2005 and 31 May 2007, and identified five men treated after the failure of both brachytherapy and EBRT for localized prostate cancer.


RESULTS
Three of the five men had iodine-seed implantation brachytherapy combined with EBRT as primary treatment, one had high-dose rate brachytherapy combined with EBRT and one had salvage iodine-seed brachytherapy for failed EBRT. Three of the five patients developed a recto-urethral fistula after HIFU.


CONCLUSIONS
The high rate of recto-urethral fistula formation in this group might reflect an impaired blood supply or HIFU-associated near-field heating of the rectal wall. Tissue viability and healing might affect this group regardless of the salvage method. Careful patient selection and avoidance of rectal diagnostic biopsies might minimize the risk. Emerging ablative therapies regarded as less invasive than traditional therapies must be used with caution.
Ahmed
Hashim U
HU
Division of Surgical and Interventional Sciences, University College London, London, UK. hashim.ahmed@ucl.ac.uk
Ishaq
Ayesha
A
Zacharakis
Evangelos
E
Shaw
Greg
G
Illing
Rowland
R
Allen
Clare
C
Kirkham
Alex
A
Emberton
Mark
M
D000368:Aged; D001918:Brachytherapy; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000150:complications / Q000628:therapy*; D012003:Rectal Fistula / Q000209:etiology*; D012007:Rectum / Q000098:blood supply; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000009:adverse effects*; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects*