Potential risk of alpha-glucosidase inhibitor administration in prostate cancer external radiotherapy by exceptional rectal gas production: a case report.

Abstract

INTRODUCTION:

Radiotherapy is a standard treatment for prostate cancer, and image-guided radiotherapy is increasingly being used to aid precision of dose delivery to targeted tissues. However, precision during radiotherapy cannot be maintained when unexpected intrafraction organ motion occurs.

CASE PRESENTATION:

We report our experience of internal organ motion caused by persistent gas production in a patient taking an alpha-glucosidase inhibitor. A 68-year-old Japanese man with prostate cancer visited our institution for treatment with helical tomotherapy. He suffered from diabetes mellitus and took an alpha-glucosidase inhibitor. Routine treatment planning computed tomography showed a large volume of rectal gas; an enema was given to void the rectum. Subsequent treatment planning computed tomography again showed a large volume of gas. After exercise (walking) to remove the intestinal gas, a third scan was performed as a test scan without tight fixation, which showed a sufficiently empty rectum for planning. However, after only a few minutes, treatment planning computed tomography again showed extreme accumulation of gas. Therefore, we postponed treatment planning computed tomography and consulted his doctor to suspend the alpha-glucosidase inhibitor, which was the expected cause of his persistent gas. Four days after the alpha-glucosidase inhibitor regimen was suspended, we took a fourth treatment planning computed tomography and made a treatment plan without gas accumulation. Thereafter, the absence of rectal gas accumulation was confirmed using daily megavolt computed tomography before treatment, and the patient received 37 fractions of intensity-modified radiotherapy at 74 Gy without rectal gas complications. In this case study, the alpha-glucosidase inhibitor induced the accumulation of intestinal gas, which may have caused unexpected organ motion, untoward reactions, and insufficient doses to clinical targets.

CONCLUSIONS:

We suggest that patients who are taking an alpha-glucosidase inhibitor for diabetes should discontinue use of that particular medicine prior to beginning radiotherapy.

• Authors: Takuya Nishimura, Hideya Yamazaki, Kazuki Iwama, Yoshitaka Oota, Norihiro Aibe, Satoaki Nakamura, Ken Yoshida, Haruumi Okabe, Kei Yamada
• Journal: Journal of medical case reports (J Med Case Rep) Vol. 8 Pg. 136 (May 05 2014) ISSN: 1752-1947 [Electronic] England
• PMID: 24886457 (Publication Type: Case Reports, Journal Article)

Chemical References

• Glycoside Hydrolase Inhibitors

Topics

• Aged
• Diabetes Mellitus, Type 2 (complications, drug therapy)
• Flatulence (chemically induced, diagnostic imaging)
• Glycoside Hydrolase Inhibitors (adverse effects)
• Humans
• Male
• Prostatic Neoplasms (complications, radiotherapy)
• Radiotherapy Planning, Computer-Assisted (methods)
• Radiotherapy, Intensity-Modulated (methods)
• Rectum (diagnostic imaging)
• Tomography, X-Ray Computed