Radiation proctitis after iodine-125 low-dose-rate prostate brachytherapy utilizing SpaceOAR hydrogel.

OBJECTIVE: We retrospectively evaluated the efficacy of combining the SpaceOAR (SOAR) hydrogel with prostate brachytherapy, using colonoscopy findings to assess for radiation proctitis. METHODS: Among 731 patients undergoing iodine-125 low-dose-rate prostate brachytherapy (LDR-BT), SOAR was utilized in 394 patients (53.9%). Colonoscopy was performed for 97 patients (13.3%) to assess the presence, location, condition, and treatment of radiation proctitis. We also investigated treatment factors associated with the occurrence of radiation proctitis. RESULTS: Radiation proctitis was observed in 57 patients (7.8%) and 17 (2.3%) were treated with argon plasma coagulation (APC). The incidence of radiation proctitis was 12.2% in the non-SOAR and 4.1% in the SOAR group (p < 0.001). In the non-SOAR group, the incidence of radiation proctitis was 6.6% for LDR-BT monotherapy and increased to 22.0% when combined with external beam radiation therapy (EBRT) (p = 0.001). However, in the SOAR group, these rates significantly decreased to 3.3% and 5.7% for monotherapy and combination therapy, respectively (p = 0.035, p < 0.001). With SOAR, inflammation was observed directly above the DL in most patients (87.5%), and only one patient (6.3%) required APC. The absence of SOAR (p < 0.001, HR = 0.29) and the concurrent use of EBRT (p = 0.018, HR = 2.87) were identified as significant risk factors for the occurrence of radiation proctitis. CONCLUSION: The use of SOAR significantly reduced the incidence of radiation proctitis in patients undergoing LDR-BT monotherapy and combined EBRT. Inflammation primarily occurred directly above the DL; further examination is necessary to clarify its cause.

Perineal recurrence of prostate ductal adenocarcinoma after transperineal brachytherapy: a case report and literature review.

Perineal recurrence after brachytherapy is an exceedingly rare complication. Moreover, ductal adenocarcinoma is a rare histological variant of prostate cancer. Herein, we describe a case of perineal recurrence from ductal adenocarcinoma of prostate after low-dose-rate brachytherapy (LDR-BT) in a 65-year-old male patient. The patient had localized prostate cancer, for which he received LDR-BT; however, he experienced perineal recurrence 2 years after receiving LDR-BT. Surgical excision was attempted, but we were unable to remove the whole tumor, owing to invasion to surrounding tissue. Pathological examination of resected tumor showed ductal adenocarcinoma of the prostate. External beam radiation therapy and high-dose-rate brachytherapy (HDR-BT) were performed for residual tumor. Mild mediastinal lymph node swelling was observed during clinical course of the disease. Hence, androgen deprivation therapy was administered with abiraterone after radiation therapy, and prostate-specific antigen level decreased to undetectable level. Biochemical failure after transperineal brachytherapy for prostate cancer should be considered as a perineal recurrence.

Role of Dental Implant Superstructure in Patients with Severe Periodontal Disease.

Many studies have investigated the relationship between periodontal disease and the onset of peri-implantitis. It is important to devise practical measures for preventing the development of peri-implantitis in patients with periodontal disease if the success of implant treatment is to be secured. Here, we report the role of the superstructure in two cases of implant treatment in patients with severe periodontal disease. Both patients had severe periodontitis and underwent implant treatment after improving the state of the disease, thereby ensuring that the implant superstructure could be maintained. Both cases remained stable after implant treatment. The results indicate that proper periodontal treatment prior to implant treatment leads to long-term success. In addition, it is necessary to use an implant superstructure that reduces plaque accumulation in preventing peri-implantitis.

Influence of titanium ions on cytokine levels of murine splenocytes stimulated with periodontopathic bacterial lipopolysaccharide.

PURPOSE: Titanium (Ti) is frequently used in dental implants because of its excellent corrosion resistance, mechanical properties, and biocompatibility. However, Ti ions may be slowly released as a result of corrosion, contributing to peri-implantitis, a major cause of dental implant failure. This study examined the influence of Ti ions on cytokine levels in murine splenocytes, an immunocompetent cell type, stimulated with Aggregatibacter actinomycetemcomitans lipopolysaccharide (LPS) and the influence of Ti ions on splenocyte viability. MATERIALS AND METHODS: Splenocytes were prepared from 5- to 10-week-old male C57BL/6 mice and BALB/c mice. Cytokine levels in culture supernatants from murine splenocytes stimulated with A actinomycetemcomitans LPS were determined with enzyme-linked immunosorbent assay. A tetrazolium salt assay was carried out to evaluate the cytotoxicity of Ti ions against murine splenocytes. RESULTS: The present study demonstrated that Ti ions influence cytokine levels in LPS-stimulated splenocytes. Significantly higher values (P < .05) were observed for interleukins 1ß, 6, and 10; interferon-γ; tumor necrosis factor alpha; and granulocyte macrophage colony-stimulating factor in the culture supernatants of LPS-stimulated splenocytes of both mouse strains in the presence of Ti ions, as compared to the absence of Ti ions. Tetrazolium salt assay confirmed that the Ti ions used in this study did not affect the viability of murine splenocytes. CONCLUSION: This study suggests that Ti ions enhanced cytokine production induced by periodontopathic bacterial LPS.