Rectotumoral fistula formation occurring more than 5 years after carbon ion radiotherapy for sacral chordoma: A case report

Ukon,Yuichiro; Outani,Hidetatsu; Nagata,Shigenori; Konishi,Eiichi; Imai,Reiko; Demizu,Yusuke; Okimoto,Tomoaki; Naka,Norifumi; Araki,Nobuhito

doi:10.3892/mco.2019.1821

Rectotumoral fistula formation occurring more than 5 years after carbon ion radiotherapy for sacral chordoma: A case report

Authors:
- Yuichiro Ukon
- Hidetatsu Outani
- Shigenori Nagata
- Eiichi Konishi
- Reiko Imai
- Yusuke Demizu
- Tomoaki Okimoto
- Norifumi Naka
- Nobuhito Araki
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Affiliations: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan, Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Osaka 541-8567, Japan, Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan, Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Chiba 263-8555, Japan, Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Hyogo 650-0047, Japan, Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo 679-5165, Japan, Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka, Osaka 541-8567, Japan
Published online on: March 5, 2019 https://doi.org/10.3892/mco.2019.1821
Pages: 487-491
Copyright: © Ukon et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Chordoma is a rare tumor that originates from the notochord. Half of chordomas involve the sacral region. Surgery is considered to be the standard treatment for sacral chordoma. However, carbon ion radiotherapy (CIRT) has recently emerged as a promising treatment for unresectable sacral chordoma. Little is known about the long-term complications of CIRT. We present two cases of rectotumoral fistula formation that occurred >5 years after CIRT for sacral chordoma. We considered two possible explanations for fistula formation: radiation enterocolitis after CIRT might cause formation of the fistula long-term, and tumor regrowth might compress the rectum and cause fistula formation. A biopsy in Case 1 showed that regrowth tumor was post-CIRT. It is important to be aware of the possibility of rectal complications after CIRT, and if found, resection of the rectum should be considered. This is a first report of rectotumoral fistula formation that occurred >5 years after CIRT for sacral chordoma.

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