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International Journal of Colorectal Disease

, Volume 35, Issue 3, pp 559–564 | Cite as

Implantation of tissue expander prior to irradiation in the era of intensity modulated radiotherapy: impact on the management of patients with pelvic digestive cancers

  • Luc Ollivier
  • Jean Marc Guilloit
  • Mélanie Dos Santos
  • Laura Guillemette
  • Carmen Florescu
  • Che Mabubu M’vondo
  • Emmanuel Meyer
  • Marie-Pierre Galais
  • Stéphane Corbinais
  • Aurelie Parzy
  • Sharmini Varatharajah
  • Paul LesueurEmail author
Short Communication

Abstract

Purpose

Before the introduction of intensity-modulated radiation therapy (IMRT), few teams used to implant a pelvic tissue expander to keep the bowel away from the radiation field, so as to reduce the risk of acute and late enteritis. However, this unexpected surgery could impact patient’s overall treatment and may be no more necessary in the era of modern radiotherapy.

Material and methods

This is a retrospective cross-sectional study including 13 patients who underwent tissue expander implantation before radiotherapy or chemoradiotherapy for rectal or anal carcinoma between November 2008 and March 2019. First, we aim to show that IMRT could sometimes be insufficient to respect dosimetric constraints, and then we aim to report the impact of tissue expander implantation on the global strategy of care of patients with anal and rectal cancers.

Results

Seventy-seven percent of the included patients were treated for anal neoplasms, while the remaining 23% had locally advanced rectal cancer. The median follow-up since implantation of the expander was 51 months [3.7–115]. Three patients recurred. One patient developed grade III toxicity related to the implantation of a tissue expander. The delay between diagnosis and the start of irradiation was significantly prolonged (median of 3 months), requiring unusual induction chemotherapy.

Conclusion

Implantation of tissue expander prior to chemoradiotherapy should be considered, even in the era of IMRT, when irradiated peritoneal cavity volume (V15Gy–V45Gy) far exceeds usual dose constraints. However, it impacts the global strategy of care by delaying the start of irradiation, by introducing induction chemotherapy, and rarely by causing post-operative complications.

Keywords

Radiotherapy  Rectal cancer Anal cancer Tissue expander Enteritis 

Notes

Authors’ contributions

Lesueur, Ollivier, Varatharajah, and Guilloit participate to the study conception design, data acquisition, and analysis and drafting the article. Guillemette participates to the data acquisition and the article conception. Dos Santos, Galais, Corbinais, Parzy, Florescu, M’vondo, and Meyer made a critical revision of manuscript. All authors participate to the data analysis and interpretation. All authors participate to the final approval of the manuscript. All authors agree to be accountable for all aspects of work to ensure that questions regarding accuracy and integrity have been investigated and resolved.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict(s) of interest.

References

  1. 1.
    Emami B, Lyman J, Brown A, Cola L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–122CrossRefGoogle Scholar
  2. 2.
    Noël G, Antoni D, Barillot I, Chauvet B (2016) Délinéation des organes à risque et contraintes dosimétriques. Cancer/Radiothérapie 20:S36–S60.  https://doi.org/10.1016/j.canrad.2016.07.032 CrossRefGoogle Scholar
  3. 3.
    Hoffman JP, Sigurdson ER, Eisenberg BL (1998) Use of saline-filled tissue expanders to protect the small bowel from radiation. Oncol Williston Park N 12:51–54; discussion 54, 60, 62, passimGoogle Scholar
  4. 4.
    Helardot PG, Wakim A, Benammar S, Habrand JL (1995) Use of expanders for protection of viscera during irradiation of pelvic tumors in children. Eur J Pediatr Surg Off J Austrian Assoc Pediatr Surg Al Z Für Kinderchir 5:27–29.  https://doi.org/10.1055/s-2008-1066157 CrossRefGoogle Scholar
  5. 5.
    Uehara S, Oue T, Adachi K et al (2015) Tissue expander placement to prevent the adverse intestinal effects of radiotherapy in malignant pelvic tumors. J Pediatr Hematol Oncol.  https://doi.org/10.1097/MPH.0000000000000437 CrossRefGoogle Scholar
  6. 6.
    (1996) Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet 348:1049–1054.  https://doi.org/10.1016/S0140-6736(96)03409-5
  7. 7.
    Bosset J-F, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123.  https://doi.org/10.1056/NEJMoa060829 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Peiffert D, Tournier-Rangeard L, Gérard J-P, Lemanski C, François E, Giovannini M, Cvitkovic F, Mirabel X, Bouché O, Luporsi E, Conroy T, Montoto-Grillot C, Mornex F, Lusinchi A, Hannoun-Lévi JM, Seitz JF, Adenis A, Hennequin C, Denis B, Ducreux M (2012) Induction chemotherapy and dose intensification of the radiation boost in locally advanced anal canal carcinoma: final analysis of the randomized UNICANCER ACCORD 03 trial. J Clin Oncol Off J Am Soc Clin Oncol 30:1941–1948.  https://doi.org/10.1200/JCO.2011.35.4837 CrossRefGoogle Scholar
  9. 9.
    Rouard N, Peiffert D, Rio E et al (2019) Intensity-modulated radiation therapy of anal squamous cell carcinoma: relationship between delineation quality and regional recurrence. Radiother Oncol J Eur Soc Ther Radiol Oncol 131:93–100.  https://doi.org/10.1016/j.radonc.2018.10.021 CrossRefGoogle Scholar
  10. 10.
    Kim A, Karotki A, Presutti J, Gonzales G, Wong S, Chu W (2017) The effect of prone and supine treatment positions for the pre-operative treatment of rectal cancer on organ-at-risk sparing and setup reproducibility using volumetric modulated arc therapy. Radiat Oncol Lond Engl 12:180.  https://doi.org/10.1186/s13014-017-0918-5 CrossRefGoogle Scholar
  11. 11.
    Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740.  https://doi.org/10.1056/NEJMoa040694 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Luc Ollivier
    • 1
    • 2
  • Jean Marc Guilloit
    • 3
  • Mélanie Dos Santos
    • 4
    • 5
  • Laura Guillemette
    • 1
  • Carmen Florescu
    • 1
  • Che Mabubu M’vondo
    • 1
  • Emmanuel Meyer
    • 1
  • Marie-Pierre Galais
    • 4
  • Stéphane Corbinais
    • 4
  • Aurelie Parzy
    • 4
  • Sharmini Varatharajah
    • 3
  • Paul Lesueur
    • 1
    • 5
    Email author
  1. 1.Centre François Baclesse, Radiation oncology DepartmentCaenFrance
  2. 2.CHRU de Brest, Radiation oncology departmentBrestFrance
  3. 3.Centre François Baclesse, Surgery DepartmentCaenFrance
  4. 4.Centre François Baclesse, Medical Oncology DepartmentCaenFrance
  5. 5.Normandy University, Université de Caen Basse NormandieCaenFrance

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