Background:
Penile toxicity after preoperative concurrent chemoradiation (CCRT) for
rectal cancers is extremely rare and only two cases of phimosis and one case of
recto-cavernosalfistula have been reported so far in literature. Preoperative
CCRT for rectal cancer is given in prone position and with the support of belly
board (BBD) to avoid small bowel toxicity. However, positional errors during
rectal radiotherapy can lead to unexpected penile toxicity. Case Presentation:
A 50-year-old Saudi male with diagnosed case of rectal adenocarcinoma stage
cT3N1M0 was given preoperative CCRT 50.4 Gy in 28 fractions with three-dimensional conformal radiation therapy
(3DCRT) in prone position using belly board with concurrent oral
capecitabine 825 mg/2 twice a day. After the completion of CCRT,
he complained of severe soreness, itching over glans penis and dysuria.
Examination revealed grade 3 erythema,
skin desquamation over glans penis (balanitis). Portal imaging of
treatment revealed glans penis to lie within posterior radiation beam. A patient
was assured and he recovered fully after local steroids and short course of
antibiotics. Conclusion: Penile toxicity after CCRT for rectal cancer is
extremely rare manifestation. Radiation oncologists and therapists must be
aware of this rare side effect and must assure proper patient education and
positioning during CCRT for rectal cancer.
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