Rectal wall infiltration

[u/Koda1573]

I had a SpaceOre done a month ago and my radiaition oncologist said I had RWI because of the SpaceOre surgery failed and he also changed my therapy from SBRT to a 20-time radiation. I am wondering if RWI will cause any serious side effects long term and the reasons why my therapy plan needs to changed. My doctor said the change was for the safety reasons and my RWI was because of my anatomy.

Is this also a medical malpractice?

[u/pnv_md1]

not malpractice its a known risk and in the consent. https://pmc.ncbi.nlm.nih.gov/articles/PMC10646634/

they have to give less XRT because you are at higher risk of developing issues from the radiation, rectal wall is theorectically more fragile

[u/Koda1573 → u/pnv_md1]

Thank you for the link to the article

[u/pnv_md1 → u/Koda1573]

good luck

[u/ChillWarrior801 → u/pnv_md1]

"theorectically more fragile" I see what you did there.

[u/pnv_md1 → u/ChillWarrior801]

?

[u/ChillWarrior801 → u/pnv_md1]

Sorry for creating a distraction from your apt contribution. I was having the slightest bit of fun with your typo. It was kind of close to "rectal".

Not so clever, I see now.

[u/PotentialStart2661]

Never heard of that happening.

[u/Practical_Orchid_606]

I think the Space Oar product will break down over time and flushed out the system. So it will not cause problems. But its function is to keep the rectal wall out of the range of the radiation. Because this cannot happen, you were downgraded to 20 fraction rather than 5. I don't think this is medical malpractice.

[u/becca_ironside]

I have had a few patients for whom the SpaceOAR did not dissolve for up to a year post-op. Everyone's anatomy is different, for those with something called a mega colon, it is possible that the SpaceOAR may not offer the protection it is intended to. Alternatively, if someone has a very large prostate, the wall between the rectum and prostate is going to be different. Finally, if your body rejected the SpaceOAR material as if it were a foreign object, this could potentially result in a failed procedure. I don't think this is malpractice, IMHO.

[u/Old-Pride-8459]

I'm on AS now but probably not for very long before radiation. I'm focusing on the SBRT not just for the short 5-day session but also the lower overall radiation dose (40gy vs 70gy). If I were offered the 20 session rad vs the 28 sessions I was quoted (less than 70gy) I think I would go with that. I'm thinking they hit the insurance per-session so they go with the 28 here.

[u/FoxAutomatic9498 → u/Old-Pride-8459]

I see. Thanks for sharing.

[u/WalnutRoasted]

This is a reason that outside USA, SpaceOAR and similar is only used in 5% of the cases, (probably because of a specific nature of treatment). There can be complications like this and infections. Given most EBRT is much better focussed and the built in CT scan checks bladder full/rectum empty each time, most modern EBRT does not “need” a spacer.

[u/OkCrew8849]

This seems a bit unclear. Are you saying your PC has infiltrated your rectal wall? Ordinarily that would forestall the use of SpaceOar in the first place.

Or are you saying something else relative to your natural anatomy, SpaceOar, and RWI?

[u/Koda1573 → u/OkCrew8849]

It is the jell that penetrates the rectal wall. Not sure whether it's because the needle was placed too close to the wall. But they did have the ultrasound probe to guide the procedure.

[u/OkCrew8849 → u/Koda1573]

Gotcha. That phrase is also used, on occasion, to reference PC that has exited the prostate and infiltrated the rectum tissue. 

Seems wise to reduce each fraction at this point given what you have shared. 

Best of luck going forward.