A dosimetric study of polyethylene glycol hydrogel in 200 prostate cancer patients treated with high-dose rate brachytherapy±intensity modulated radiation therapy

Ström, T.; Wilder, Richard B.; Fernandez, Daniel C.; Mellon, Eric A.; Saini, Amarjit; Hunt, David E.; Pow‐Sang, Julio M.; Spiess, Phillippe E.; Sexton, Wade J.; Poch, Michael; Biagioli, Matthew C.

doi:10.1016/j.radonc.2014.02.011

Cited by 47 publications

(65 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As demonstrated in several studies, the injection or insertion of a spacer results in a distance of about 1.0-1.5 cm between the prostate and rectum, so that the rectal wall and planning target volume do not overlap [11][12][13]21] . The largest study included 100 patients after hydrogel injection [22] . A higher injected volume can result in a larger separation.…”

Section: Treatment Planningmentioning

confidence: 99%

“…A higher injected volume can result in a larger separation. Hydrogel is usually inserted in standardized 10-15 mL systems [14,22] . Comparably to the hydrogel studies, a mean separation of 12.7 mm was achieved with 20 mL human collagen injections in a pilot study [12] .…”

Section: Treatment Planningmentioning

confidence: 99%

“…Though different injection volumes have not been compared in studies, an increasing volume can be potentially associated with toxicity related to the pressure on the rectal wall or even the prostate. A volume of 10-15 mL and a resulting distance of 1.0-1.5 cm appear to be very effective and well tolerable for the patients [11][12][13][14]22] . This separation results in a considerable dosimetric advantage for the rectum.…”

Section: Treatment Planningmentioning

confidence: 99%

“…Spacer studies have been reported after several different treatment concepts, as low-dose rate [24] and highdose rate (HDR) brachytherapy [22,25] with or without additional EBRT, hypofractionated EBRT concepts [26] or proton and heavy ion concepts [27,28] . Rare spacer-related complications have been reported in the literature, as focal rectal necrosis or ulceration as a result of unintentional injection of hydrogel into the rectal wall or urinary retention, usually resolving within a short time [14] .…”

Section: Clinical Experiencementioning

confidence: 99%

See 3 more Smart Citations

Current role of spacers for prostate cancer radiotherapy

Pinkawa

2015

WJCO

View full text Add to dashboard Cite

Radiotherapy is an established curative treatment method for prostate cancer. Optimal tumor control rates can only be achieved with high local doses, associated with a considerable risk of rectal toxicity. Apart from already widely adapted technical advances, as intensity-modulated radiation therapy, the application of spacers placed between the prostate and rectum has been increasingly used in the last years. Biodegradable spacers, including hydrogel, hyaluronic acid, collagen or an implantable balloon, can be injected or inserted in a short procedure under transrectal ultrasound guidance via a transperineal approach. A distance of about 1.0-1.5 cm is usually achieved between the rectum and prostate, excluding the rectal wall from the high isodoses. Several studies have shown well tolerated injection procedures and treatments. Apart from considerable reduction of rectal irradiation, a prospective randomized trial demonstrated a reduction of rectal toxicity after hydrogel injection in men undergoing prostate image-guided intensity-modulated radiation therapy. The results are encouraging for continuing evaluation in dose escalation, hypofractionation, stereotactic radiotherapy or re-irradiation trials in the future.

show abstract

Section: Treatment Planningmentioning

confidence: 99%

Section: Treatment Planningmentioning

confidence: 99%

Section: Treatment Planningmentioning

confidence: 99%

Section: Clinical Experiencementioning

confidence: 99%

See 2 more Smart Citations

Current role of spacers for prostate cancer radiotherapy

Pinkawa

2015

WJCO

View full text Add to dashboard Cite

show abstract

“…Each had DuraSeal™ gel (Covidien, Mansfield, MA, USA) inserted percutaneously through the peritoneum posterior to Denonvillier's fascia and anterior to the rectum. An ultrasound image‐guided injection of the gel (5 ml) via 16‐guage catheter was performed to the level of the mid prostate gland to slowly separate the anterior perirectal fat, thus creating a space for the gel at the level of the mid prostate gland 30. The injection of DuraSeal™ gel was done prior to CT simulation by a radiation oncologist with significant brachytherapy experience (M.B.…”

Section: Methodsmentioning

confidence: 99%

Rectal dose to prostate cancer patients treated with proton therapy with or without rectal spacer

Chung

Polf

Badiyan

et al. 2016

J Applied Clin Med Phys

View full text Add to dashboard Cite

The purpose of this study was to evaluate whether a spacer inserted in the prerectal space could reduce modeled rectal dose and toxicity rates for patients with prostate cancer treated in silico with pencil beam scanning (PBS) proton therapy. A total of 20 patients were included in this study who received photon therapy (12 with rectal spacer (DuraSeal™ gel) and 8 without). Two PBS treatment plans were retrospectively created for each patient using the following beam arrangements: (1) lateral‐opposed (LAT) fields and (2) left and right anterior oblique (LAO/RAO) fields. Dose volume histograms (DVH) were generated for the prostate, rectum, bladder, and right and left femoral heads. The normal tissue complication probability (NTCP) for ≥grade 2 rectal toxicity was calculated using the Lyman–Kutcher–Burman model and compared between patients with and without the rectal spacer. A significantly lower mean rectal DVH was achieved in patients with rectal spacer compared to those without. For LAT plans, the mean rectal V70 with and without rectal spacer was 4.19 and 13.5%, respectively. For LAO/RAO plans, the mean rectal V70 with and without rectal spacer was 5.07 and 13.5%, respectively. No significant differences were found in any rectal dosimetric parameters between the LAT and the LAO/RAO plans generated with the rectal spacers. We found that ≥ 9 mm space resulted in a significant decrease in NTCP modeled for ≥grade 2 rectal toxicity. Rectal spacers can significantly decrease modeled rectal dose and predicted ≥grade 2 rectal toxicity in prostate cancer patients treated in silico with PBS. A minimum of 9 mm separation between the prostate and anterior rectal wall yields the largest benefit.

show abstract

Biological effective dose in analysis of rectal dose in prostate cancer patients who underwent a combination therapy of VMAT and LDR with hydrogel spacer insertion

Zhang

Wang

Riegel

et al. 2022

J Applied Clin Med Phys

View full text Add to dashboard Cite

This study aimed to evaluate rectal dose reduction in prostate cancer patients who underwent a combination of volumetric modulated arc therapy (VMAT) and low-dose-rate (LDR) brachytherapy with insertion of hydrogel spacer (SpaceOAR). For this study, 35 patients receiving hydrogel spacer and 30 patients receiving no spacer were retrospectively enrolled. Patient was treated to doses of 45 Gy to the primary tumor site and nodal regions over 25 fractions using VMAT and 100 Gy to the prostate using prostate seed implant (PSI). In VMAT plans of patients with no spacer, mean doses of rectal wall were 43.6, 42.4, 40.1, and 28.8 Gy to the volume of 0.5, 1, 2, and 5 cm 3 , respectively. In patients with SpaceOAR, average rectal wall doses decreased to 39.0, 36.9, 33.5, and 23.9 Gy to the volume of 0.5, 1, 2, and 5 cm 3 , respectively (p < 0.01). In PSI plans, rectal wall doses were on average 78.5, 60.9, 41.8, and 14.8 Gy to the volume of 0.5, 1, 2, and 5 cm 3 , respectively, in patients without spacer. In contrast, the doses decreased to 34.5, 28.4, 20.6 (p < 0.01), and 8.5 Gy (p < 0.05) to rectal wall volume of 0.5, 1, 2, and 5 cm 3 , respectively, in patient with SpaceOAR. To demonstrate rectal sum dose sparing, dose-biological effective dose (BED) calculation was accomplished in those patients who showed >60% overlap of rectal volumetric doses between VMAT and PSI. In patients with SpaceOAR, average BED sum was decreased up to 34%, which was 90.1, 78.9, 65.9, and 40.8 Gy to rectal volume of 0.5, 1, 2, and 5 cm 3 , respectively, in comparison to 137.4, 116.7, 93.0, and 50.2 Gy to the volume of 0.5, 1, 2, and 5 cm 3 , respectively, in those with no spacer. Our result suggested a significant reduction of rectal doses in those patients who underwent a combination of VMAT and LDR with hydrogel spacer placement.

show abstract

A dosimetric study of polyethylene glycol hydrogel in 200 prostate cancer patients treated with high-dose rate brachytherapy±intensity modulated radiation therapy

Cited by 47 publications

References 29 publications

Current role of spacers for prostate cancer radiotherapy

Current role of spacers for prostate cancer radiotherapy

Rectal dose to prostate cancer patients treated with proton therapy with or without rectal spacer

Biological effective dose in analysis of rectal dose in prostate cancer patients who underwent a combination therapy of VMAT and LDR with hydrogel spacer insertion

Contact Info

Product

Resources

About