title: Rectal fistulae after salvage high-intensity focused ultrasound for recurrent prostate cancer after combined brachytherapy and external beam radiotherapy.
abstract: 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.
authors.affiliation: Division of Surgical and Interventional Sciences, University College London, London, UK. hashim.ahmed@ucl.ac.uk
authors.forename: Hashim U
authors.initials: HU
authors.lastname: Ahmed
authors.forename: Ayesha
authors.initials: A
authors.lastname: Ishaq
authors.forename: Evangelos
authors.initials: E
authors.lastname: Zacharakis
authors.forename: Greg
authors.initials: G
authors.lastname: Shaw
authors.forename: Rowland
authors.initials: R
authors.lastname: Illing
authors.forename: Clare
authors.initials: C
authors.lastname: Allen
authors.forename: Alex
authors.initials: A
authors.lastname: Kirkham
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
mesh_terms: 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*