Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany.
Strahlenther Onkol. 2019 May;195(5):441-446. doi: 10.1007/s00066-018-1401-4. Epub 2018 Nov 23.
To report the development of an ultimately fatal occurrence of Fournier's gangrene in a rectal cancer patient undergoing neoadjuvant radiotherapy without chemotherapy.
A 53-year-old male patient with G2 cT3 cN1a cM0 stage IIIB adenocarcinoma of the lower rectum and several comorbidities including ulcerative colitis was treated with 56 Gy to the primary tumor in 28 fractions because he declined the recommended simultaneous chemotherapy. He was also enrolled in the ketogenic diet arm of our KETOCOMP study, so that prospective measurements of blood parameters, quality of life, and body composition were made.
The patient died 6 days after completion of radiotherapy due to septic shock associated with Fournier's gangrene reaching from the right buttock into the gluteal muscles and descending into the scrotum. In retrospect, there were several signs probably indicating the development of the gangrene: (i) a decline in bioelectrical phase angle; (ii) an accelerated weight and fat-free mass loss starting in the third week of radiotherapy; (iii) an increase in C-reactive protein (CRP) and concurrent drop in high-density lipoprotein (HDL) cholesterol and insulin-like growth factor(IGF)-1 concentrations; and (iv) the occurrence of a sharp pain in the perianal region reported in the fifth week of radiotherapy. Notably, his self-reported quality of life score was the same at the end of as before radiotherapy.
This case highlights the occurrence of Fournier's gangrene as an extremely rare but life-threatening complication during neoadjuvant radiotherapy for rectal cancer which should be refreshed in the awareness of radiation oncologists and radiologists.
报告一例接受新辅助放疗（无化疗）的直肠癌患者发生福尼尔坏疽的致命性终末事件。
一名 53 岁男性患者患有 G2 cT3 cN1a cM0 期 IIIB 低位直肠腺癌和多种合并症，包括溃疡性结肠炎。由于拒绝接受推荐的同步化疗，该患者接受了 56Gy 的原发肿瘤 28 次分割放疗。他还参加了我们的 KETOCOMP 研究的生酮饮食组，因此前瞻性地测量了血液参数、生活质量和身体成分。
患者在放疗完成后 6 天因与福尼尔坏疽相关的感染性休克死亡，坏疽从右臀部蔓延至臀肌，并下降至阴囊。回顾性分析发现，有几个迹象可能表明坏疽的发生：（i）生物电阻抗相位角下降；（ii）放疗第 3 周开始体重和去脂体重加速丢失；（iii）C 反应蛋白（CRP）升高，同时高密度脂蛋白（HDL）胆固醇和胰岛素样生长因子（IGF-1）浓度下降；（iv）放疗第 5 周报告肛周区域出现剧烈疼痛。值得注意的是，他报告的生活质量评分在放疗结束时与放疗前相同。
该病例强调了福尼尔坏疽作为一种极其罕见但危及生命的并发症，在直肠癌新辅助放疗中应引起放射肿瘤学家和放射科医生的重视。
