Hydrogel injection reduces rectal toxicity after radiotherapy for localized prostate cancer

Pinkawa, Michael; Berneking, Vanessa; König, Liane; Frank, Dario; Bretgeld, Marilou; Eble, Michael J.

doi:10.1007/s00066-016-1040-6

Cited by 29 publications

(49 citation statements)

References 28 publications

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“…A few studies have examined long‐term toxicities in patients treated with IMRT for prostate cancer with and without SpaceOAR. Our report therefore adds to the available information, which is summarised in Table . After a minimum follow‐up of 2 years, Whalley et al reported lower rates of late grade 1 gastrointestinal toxicity in their SpaceOAR group (16.6%) compared to patients treated without a SpaceOAR (41.8%).…”

Section: Discussionmentioning

confidence: 79%

“…Our report therefore adds to the available information, which is summarised in Table 3. [13][14][15][16] After a minimum follow-up of 2 years, Whalley et al 15 reported lower rates of late grade 1 gastrointestinal toxicity in their SpaceOAR group (16.6%) compared to patients treated without a SpaceOAR (41.8%). A single-blind, randomised trial of 222 eligible men from 20 participating institutions 14 reported benefits of the SpaceOAR gel at 15 months for bowel toxicity; quality of life (QOL) was maintained or had increased at 3 years.…”

Section: Discussionmentioning

confidence: 99%

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Late toxicities of prostate cancer radiotherapy with and without hydrogel SpaceAOR insertion

et al. 2019

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Introduction To investigate whether the implantation of a hydrogel spacer (SpaceOAR) reduces long‐term rectal toxicity for prostate cancer patients treated with intensity‐modulated radiotherapy (IMRT). Methods Patients with localised prostate cancer treated with 81 Gy in 45 fx of IMRT over 9 weeks were retrospectively compared: 65 patients with SpaceOAR and 56 patients without SpaceOAR. Planning aims restricted rectal doses to V40 Gy < 35%, V65 Gy < 17%, V75 Gy < 10%. Toxicities were evaluated between 3 months and 3 years after the completion of radiotherapy and were based on the common terminology criteria for adverse events (CTCAE) assessment tool for diarrhoea, haemorrhoids, faecal incontinence and proctitis. Results The cumulative incidence of low‐grade diarrhoea (G1) was significantly higher in the non‐SpaceOAR group (21.4% vs 6.2%; P = 0.016). The cumulative incidence of proctitis (grades G1 and G2) was also higher in the non‐SpaceOAR group (26.7% vs 9.2%; P = 0.015); the cumulative incidence of G2 proctitis was higher in the latter group (P = 0.043). There were no differences between the treatment groups for cumulative incidences of faecal incontinence and/or haemorrhoids. Three years after IMRT, diarrhoea and proctitis were higher in the non‐SpaceOAR group, without reaching statistical significance. This finding was unchanged after correcting for baseline symptoms. Conclusion SpaceOAR is of benefit in reducing the cumulative incidence of low‐grade diarrhoea and proctitis for up to 3 years after intensity‐modulated radiotherapy.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Late toxicities of prostate cancer radiotherapy with and without hydrogel SpaceAOR insertion

et al. 2019

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“…The authors reported similar results to our present study, with no significant adverse events related to HS injection and no differences in the rates of acute rectal toxicity between the HS and control groups. Another study by Pinkawa et al , reported on 167 consecutive patients treated either with HS ( n = 110) or without HS ( n = 66), whilst undergoing prostate RT up to a maximum dose of 80 Gy. These authors also reported similar findings to our present study, in that the HS injection was found to result in favourable rectal dosimetry with minimal acute rectal toxicity during and shortly after RT.…”

Section: Discussionmentioning

confidence: 99%

Prospective analysis of hydrogel spacer for patients with prostate cancer undergoing radiotherapy

Chao

Ho²,

Chan

et al. 2018

BJU International

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“…Most experience with hydrogel injection has been in the region between the prostate and rectum for men receiving dose-escalated prostate RT (25-28). Recently reported results of a phase III study of dose-escalated IMRT for prostate cancer in 222 men randomized 2:1, with and without spacer placement, respectively, demonstrated a reduced rectal dose and toxicity and improved quality of life (25).…”

Section: Discussionmentioning

confidence: 99%

“…Previously, hydrogel injection for spacing organs at risk (OARs) from the radiation target to increase the deliverable dose or improve the safety of RT has been evaluated most extensively in the treatment of prostate cancer (25-28), with some experience in gynecologic cancers as well (29). Hydrogel spacer injection between the rectum and prostate and seminal vesicles has resulted in a reduced rectal dose and toxicity and improved quality of life (25).…”

Section: Introductionmentioning

confidence: 99%

A Novel Absorbable Radiopaque Hydrogel Spacer to Separate the Head of the Pancreas and Duodenum in Radiation Therapy for Pancreatic Cancer

Rao

Feng

Shin³

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Summary We have demonstrated the feasibility of an endoscopic ultrasound-guided injectable hydrogel separation technique using a cadaveric model to increase the space between the head of the pancreas and duodenum. Using modeling studies, we identified the minimum distance of this separation for optimal sparing of the duodenum, setting the foundation for future clinical trials using this technique to enable dose escalation with either stereotactic or intensity-modulated radiation therapy for patients with unresectable pancreatic cancer. Purpose We assessed the feasibility and theoretical dosimetric advantages of an injectable hydrogel to increase the space between the head of the pancreas (HOP) and duodenum in a human cadaveric model. Methods and Materials Using 3 human cadaveric specimens, an absorbable radiopaque hydrogel was injected between the HOP and duodenum by way of open laparotomy in 1 case and endoscopic ultrasound (EUS) guidance in 2 cases. The cadavers were subsequently imaged using computed tomography and dissected for histologic confirmation of hydrogel placement. The duodenal dose reduction and planning target volume (PTV) coverage were characterized using pre- and postspacer injection stereotactic body radiation therapy (SBRT) plans for the 2 cadavers with EUS-guided placement, the delivery method that appeared the most clinically desirable. Modeling studies were performed using 60 SBRT plans consisting of 10 previously treated patients with unresectable pancreatic cancer, each with 6 different HOP–duodenum separation distances. The duodenal volume receiving 15 Gy (V15), 20 Gy (V20), and 33 Gy (V33) was assessed for each iteration. Results In the 3 cadaveric studies, an average of 0.9 cm, 1.1 cm, and 0.9 cm HOP–duodenum separation was achieved. In the 2 EUS cases, the V20 decreased from 3.86 cm3 to 0.36 cm3 and 3.75 cm3 to 1.08 cm3 (treatment constraint <3 cm3), and the V15 decreased from 7.07 cm3 to 2.02 cm3 and 9.12 cm3 to 3.91 cm3 (treatment constraint <9 cm3). The PTV coverage improved or was comparable between the pre- and postinjection studies. Modeling studies demonstrated that a separation of 8 mm was sufficient to consistently reduce the V15, V20, and V33 to acceptable clinical constraints. Conclusions Currently, dose escalation has been limited owing to radiosensitive structures adjacent to the pancreas. We demonstrated the feasibility of hydrogel separation of the HOP and duodenum. Future studies will evaluate the safety and efficacy of this technique with the potential for more effective dose escalation using SBRT or intensity-modulated radiation therapy to improve the outcomes in patients with unresectable pancreatic cancer.

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Hydrogel injection reduces rectal toxicity after radiotherapy for localized prostate cancer

Abstract: Spacer injection is associated with a significant benefit for patients after prostate cancer RT.

Cited by 29 publications

References 28 publications

Late toxicities of prostate cancer radiotherapy with and without hydrogel SpaceAOR insertion

Late toxicities of prostate cancer radiotherapy with and without hydrogel SpaceAOR insertion

Prospective analysis of hydrogel spacer for patients with prostate cancer undergoing radiotherapy

A Novel Absorbable Radiopaque Hydrogel Spacer to Separate the Head of the Pancreas and Duodenum in Radiation Therapy for Pancreatic Cancer

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