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Reducing rectal injury in men receiving prostate cancer radiation therapy: current perspectives

Authors Serrano NA, Kalman NS, Anscher MS

Received 6 May 2017

Accepted for publication 29 June 2017

Published 28 July 2017 Volume 2017:9 Pages 339—350

DOI https://doi.org/10.2147/CMAR.S118781

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Kenan Onel


Nicholas A Serrano,1 Noah S Kalman,1 Mitchell S Anscher2

1Department of Radiation Oncology, Virginia Commonwealth University – Massey Cancer Center, Richmond, VA, 2Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

Abstract: Dose escalation is now the standard of care for the treatment of prostate cancer with radiation therapy. However, the rectum tends to be the dose-limiting structure when treating prostate cancer, given its close proximity. Early and late toxicities can occur when the rectum receives large doses of radiation therapy. New technologies allow for prevention of these toxicities. In this review, we examine the evidence that supports various dose constraints employed to prevent these rectal injuries from occurring. We also examine the use of intensity-modulated radiation therapy and how this compares to older radiation therapy techniques that allow for further sparing of the rectum during a radiation therapy course. We then review the literature on endorectal balloons and the effects of their daily use throughout a radiation therapy course. Tissue spacers are now being investigated in greater detail; these devices are injected into the rectoprostatic fascia to physically increase the distance between the prostate and the anterior rectal wall. Last, we review the use of systemic drugs, specifically statin medications and antihypertensives, as well as their impact on rectal toxicity.

Keywords: rectal toxicity, radiation therapy, prostate, prevention
 

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