Abscess formation following hydrogel spacer for prostate cancer radiotherapy: a rare complication

Hoe, Venetia; Yao, Henry Han‐I; Huang, James Guoxian; Guerrieri, Mario

doi:10.1136/bcr-2018-229143

Cited by 11 publications

(11 citation statements)

References 8 publications

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“…Although the studies evaluated in this review reported SpaceOAR to be well tolerated, with no or only mild to moderate procedure-related complications, other studies in literature have reported more serious, yet rare, complications such as rectal fistulas/ulcers, 29,30 rectal necrosis 31 and periprostatic abscesses. 32 These rare complications are important to be aware of as there is a learning curve for physicians when applying SpaceOAR to achieve symmetrical placement, improved treatment planning and less procedure-related complications. 33 However, the hydro-dissection training needed for SpaceOAR placement is safe and easy to learn 34 with 98.7% of the radiation oncologists and urologists who applied the SpaceOAR rated the device's ease of use as 'easy' or 'very easy'.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: A systematic review

Babar¹,

Katz

Ciatto³

2021

J Med Imag Rad Onc

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SpaceOAR, an absorbable polyethylene glycol hydrogel, increases the space between the prostate and rectum to reduce the radiation received by the rectum during prostate cancer radiation therapy. The objective of this systematic review was to evaluate controlled studies on the dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer. Eight studies were included in the review. All of the studies showed SpaceOAR to reduce the radiation dose volume to the rectum over numerous dosimetry levels. Of the four studies that assessed toxicity, one reported SpaceOAR to significantly decrease acute Grade 1 diarrhoea and two reported SpaceOAR to significantly decrease late Grade 1 and Grade ≥2 rectal toxicities. Two studies assessed cumulative incidence of toxicity at 3 years in which one reported SpaceOAR to significantly decrease urinary incontinence and Grade ≥1 and Grade ≥2 rectal toxicities, and the other reported SpaceOAR to significantly decrease Grade 1 diarrhoea and Grade 2 proctitis. Moreover, one study reported that fewer SpaceOAR patients experienced 10-point declines in bowel quality of life at 3 years, but another study reported no significant difference in 10-point declines in bowel quality of life between the SpaceOAR and control groups at 5 years. With the current research available, SpaceOAR may be beneficial to those who did not meet the standard rectal dose-volume criteria, have higher risk factors of developing rectal toxicities post-radiation, or wish to decrease the length and costs of radiotherapy by increasing the dose of radiation per fraction.

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Section: Discussionmentioning

confidence: 99%

Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: A systematic review

Babar¹,

Katz

Ciatto³

2021

J Med Imag Rad Onc

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“…However, in our case, SpaceOAR was inserted into the correct space between the prostate and the rectum, confirmed by MRI. A peri-prostate abscess is a rare side effect of SpaceOAR [ 15 ]. In our study, after improvement of the peri-SpaceOAR abscess, rectal perforation was detected after EBRT.…”

Section: Discussionmentioning

confidence: 99%

“…A prospective randomised study revealed that insertion of SpaceOAR significantly reduced the rectal dose and toxicity and improved bowel/urinary quality of life [12][13][14]. On the other hand, a patient who developed periprostatic abscess formation after SpaceOAR insertion was reported [15]; however, it was not clear whether SpaceOAR insertion was successful, although the infection improved after percutaneous drainage. Periprostatic abscess is a rare adverse effect of SpaceOAR, and the association between aggravation of abscesses and radiotherapy has not been clarified.…”

Section: Introductionmentioning

confidence: 99%

The use of hyperbaric oxygen to treat actinic rectal fistula after SpaceOAR use and radiotherapy for prostate cancer: a case report

Kashihara

Inaba

Komiyama³

et al. 2020

BMC Urol

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Background In definitive radiation therapy for prostate cancer, the SpaceOAR® System, a hydrogel spacer, is widely used to decrease the irradiated dose and toxicity of rectum. On the other hand, periprostatic abscesses formation and rectal perforation are known as rare adverse effects of SpaceOAR. Nevertheless, there is a lack of reports clarifying the association between aggravation of abscesses and radiation therapy, and hyperbaric oxygen therapy (HBOT) is effective for a peri-SpaceOAR abscess and rectal perforation. Case presentation We report a case of a 78-year-old high-risk prostate cancer patient. After SpaceOAR insertion into the correct space, he started to receive external beam radiation therapy (EBRT). He developed a fever, perineal pain and frequent urination after the completion of EBRT, and the magnetic resonance imaging (MRI) revealed a peri-SpaceOAR abscess. Scheduled brachytherapy was postponed, administration of antibiotics and opioid via intravenous drip was commenced, and transperineal drainage was performed. After the alleviation of the abscess, additional EBRT instead of brachytherapy was performed with MRI-guided radiation therapy (MRgRT). On the last day of the MRgRT, perineal pain reoccurred, and MRI and colonoscopy detected the rectal perforation. He received an intravenous antibiotics drip and HBOT, and fully recovered from the rectal perforation. Conclusions Our report indicates that EBRT can lead to a severe rectum complication by causing inflammation for patients with a peri-SpaceOAR abscess. Furthermore, HBOT was effective for the peri-SpaceOAR abscess and rectal perforation associated with EBRT.

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“…Only three published papers were found to describe adverse events from hydrogel spacer insertion, which included rectal wall ulcers, abscess, local inflammation, and local rectal injury or symptoms. [16][17][18] It was therefore assumed to have negligible impact on model outcomes. A five-year time horizon post-EBRT treatment was applied based on evidence that chronic toxicity requiring medical intervention was unlikely beyond this timeframe.…”

Section: Model Development and Structurementioning

confidence: 99%

Cost‐effectiveness analysis of hydrogel spacer for rectal toxicity reduction in prostate external beam radiotherapy

et al. 2021

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Introduction: Contemporary methods of external beam radiotherapy for prostate cancer have reduced toxicity rates through beam modulation and image guidance, however, rectal injury has not been eliminated completely in this population. For patients at greatest risk of developing rectal toxicities, hydrogel spacers are a viable option for risk reduction. Translation of clinical trial results into routine clinical practice relies on an understanding of the economic implications. This study completed a cost-effectiveness analysis of hydrogel spacers in the Australian healthcare setting. Method: Simulation of possible health states following treatment was performed using a Markov model. Model outcomes included the incremental costeffectiveness ratio and the net monetary benefit (NMB) at three published willingness-to-pay thresholds derived from literature. Probabilistic sensitivity analyses were provided on these results. A baseline cohort without hydrogel spacer use was compared to treat all and selective use cohorts. Cost variation scenarios were also investigated to assess the impact of hydrogel spacer cost on outcomes. Results: Using hydrogel spacers in a selective cohort was more likely to be cost-effective than giving to all patients (NMB À$43 versus À$997, respectively); however, the incremental cost-effectiveness ratio was not below the $28 000 willingness-to-pay threshold for a healthcare provider perspective. These outcomes were influenced by large parameter uncertainty. Cost variation strategies are worth investigating further as a method to achieve willingness-to-pay threshold targets. Conclusion:The influence of parameter uncertainty currently limits the costeffectiveness of this intervention in the Australian public health setting. However, a cost variation solution has been demonstrated to improve costeffectiveness estimates for selected patients and should be examined further.

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Abscess formation following hydrogel spacer for prostate cancer radiotherapy: a rare complication

Cited by 11 publications

References 8 publications

Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: A systematic review

Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: A systematic review

The use of hyperbaric oxygen to treat actinic rectal fistula after SpaceOAR use and radiotherapy for prostate cancer: a case report

Cost‐effectiveness analysis of hydrogel spacer for rectal toxicity reduction in prostate external beam radiotherapy

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