Implantation of a biodegradable rectum balloon implant: Tips, Tricks and Pitfalls

Abstract

Introduction:A rectum balloon implant (RBI) is a new device to spare rectal structures during prostate cancer radiotherapy. The theoretical advantages of a RBI are to reduce the high radiation dose to the anterior rectum wall, the possibility of a post-implant correction, and their predetermined shape with consequent predictable position.Objective:To describe, step-by-step, our mini-invasive technique for hands-free transperineal implantation of a RBI before start of radiotherapy treatment.Materials and Methods:We provide step-by-step instructions for optimization of the transperineal implantation procedure performed by urologists and/or radiation oncologists experienced with prostate brachytherapy and the use of the real-time bi-plane transrectal ultrasonography (TRUS) probe. A RBI was performed in 15 patients with localised prostate cancer. Perioperative side-effects were reported.Results:We provide ‘tips and tricks’ for optimizing the procedure and proper positioning of the RBI. Please watch the animation, see video in https://vimeo.com/205852376/789df4fae4.The side-effects included mild discomfort to slight pain at the perineal region in 8 out of 15 patients. Seven patients (47%) had no complaints at all. Two patients developed redness of the skin, where prompt antibiotic regimen was started with no further sequelae. One patient revealed a temporary urine retention, which resolved in a few hours following conservative treatment. Further no perioperative complications occurred.Conclusion:This paper describes in detail the implantation procedure for an RBI. It is a feasible, safe and very well-tolerated procedure.

Development of a virtual spacer to support the decision for the placement of an implantable rectum spacer for prostate cancer radiotherapy: Comparison of dose, toxicity and cost-effectiveness

“…An appropriate expansion to the system would be to include NTCP models for these types of toxicities. The possible complications after placement of the IRS (pain, rectal perforation) were not taken into account, as the risk of these factors is low (<5%) [27], and are not yet fully described. Furthermore, the nomograms on which the NTCP model is based are from 2002 to 2004, where now outdated dose delivery techniques were conformal.…”

Development of an isotoxic decision support system integrating genetic markers of toxicity for the implantation of a rectum spacer

“…However, the method presented here has the potential to identify patients with this SNP who could be treated safely with radiotherapy after placement of an IRS. This would be beneficial, since placing an IRS is less invasive and has a very low to no impact on the quality of life, especially in comparison with surgery [8]. This would also be beneficial for patients who don't want an operation or who are not candidates for surgery.…”

“…The implantable rectum spacer (IRS) is a device developed to spare the rectum by increasing the distance between the anterior rectal wall and the prostate, thus reducing the overlap between the rectal wall and the high-dose region [6][7][8][9]. Recent studies have shown that this device significantly reduces the dose in the rectum, thus reducing the risk of complications, for approximately 20% of the patients [5].…”

Dynamics of rectal balloon implant shrinkage in prostate VMAT

“…The RBI has some practical advantages [ 9 ]. First of all postimplant correction of the RBI position is possible; if the RBI is dispositioned, it can be easily deflated and replaced, whereas liquid spacers (PEG hydrogels, hyaluronic acid, human collagen) do not permit any correction once being injected [ 9 , 12 ]. In addition, a chemical reaction is required to occur in PEG hydrogels, which limits the implantation time.…”

“…An RBI was implanted in these patients between the prostate and the anterior rectal wall 7–10 days prior to the start of EBRT. The injection technique has been previously described in detail [ 12 ]. A short general anesthesia is preferred at our department.…”