Unusual Case of Radiation Induced Balanitis after Chemoradiation for Upper Rectal Adenocarcinoma

Abstract

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 re vealed 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.