Polyethylene glycol hydrogel rectal spacer implantation in patients with prostate cancer undergoing combination high-dose-rate brachytherapy and external beam radiotherapy

Yeh, Jekwon; Lehrich, Brandon M.; Tran, Carolyn; Mesa, Albert; Baghdassarian, Ruben; Yoshida, Jeffrey; Torrey, Robert; Gazzaniga, Michael S.; Weinberg, Alan C.; Chalfin, Stuart; Ravera, John; Tokita, Kenneth

doi:10.1016/j.brachy.2015.12.007

Cited by 31 publications

(46 citation statements)

References 13 publications

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“…These rates are not that dissimilar from our baseline‐corrected rates of diarrhoea and proctitis, respectively: 1.7% and 1.7% in the SpaceOAR group vs 7.3% and 7.2% in the non‐SpaceOAR group. As the uptake of hypofractionation protocols increases, the benefit of SpaceOAR might potentially also increase as higher radiation doses may translate into an increased risk of normal tissue damage …”

Section: Discussionmentioning

confidence: 99%

“…As the uptake of hypofractionation protocols increases, the benefit of SpaceOAR might potentially also increase as higher radiation doses may translate into an increased risk of normal tissue damage. 17,18 It was reassuring to find that patients with SpaceOAR had fewer biochemical failures than patients without SpaceOAR (3.0% vs 8.2%). Of the 7 PSA failures, PSMA PETs revealed that only two patients had local failure, and neither local failure was in the SpaceOAR group.…”

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: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…There was also a trend towards less late GI toxicity in the HS group. More so, early experiences with a rectal spacer in conjunction with LDR and HDR brachytherapy yielded other favourable clinical and dosimetric results . In the study by Beydoun et al .…”

Section: Discussionmentioning

confidence: 99%

“…More so, early experiences with a rectal spacer in conjunction with LDR and HDR brachytherapy yielded other favourable clinical and dosimetric results. 24,25 In the study by Beydoun et al 24 in which five patients received I-125 seed brachytherapy implant and HS gel for T1 prostate adenocarcinoma, Grade 1 adverse effects were restricted to perineal pain and rectal discomfort. No Grade 2 rectal toxicities were reported.…”

Section: Discussionmentioning

confidence: 99%

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High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes

et al. 2019

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Introduction To examine the long‐term outcomes of high dose rate brachytherapy boost (HDR‐BT) combined with external beam radiotherapy (EBRT) for intermediate and high‐risk prostate cancer patients. Methods Data from 95 patients who underwent combined EBRT (50.4 Gy) and HDR‐BT to the prostate between 2010 and 2017 were retrospectively analysed. Biochemical progression free survival (bPFS), local recurrence free survival (LRFS), metastatic free survival (MFS) and overall survival (OS) were estimated using Kaplan–Meier method. Regression analysis was conducted to identify important predictors of outcomes. Results A total of 24 patients received an initial HDR‐BT dose of 18 Gy in three fractions, with the remaining 71 patients receiving 16 Gy in two fractions as per departmental protocol changes. Most patients (88%) received androgen deprivation therapy. A transurethral resection of the prostate (TURP) was performed in 14 patients and hydrogel spacers (HS) were used in 30 patients. Median follow‐up was 58 months. The 5‐year bPFS, LRFS, MFS and OS were 92%, 100%, 92% and 88%. Univariate regression revealed no statistical association between patient characteristics and time to relapse (all P > 0.1). Late > grade 2 genitourinary (GU) toxicity was 6.3%. The use of HS or prior TURP had no impact on late GU toxicity. Late Grade 1 gastrointestinal (GI) toxicity was 5.3%. Conclusion The combined HDR‐BT with EBRT resulted in excellent bPFS. The cumulative risk of late GU and GI toxicity was low and can be further improved with preventative strategies such as a pre‐emptive TURP and/or HS insertion.

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AAPM task group report 303 endorsed by the ABS: MRI implementation in HDR brachytherapy—Considerations from simulation to treatment

et al. 2022

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The task group (TG) on magnetic resonance imaging (MRI) implementation in high-dose-rate (HDR) brachytherapy (BT)-Considerations from simulation to treatment, TG 303, was constituted by the American Association of Physicists in Medicine's (AAPM's) Science Council under the direction of the Therapy Physics Committee, the Brachytherapy Subcommittee, and the Working Group on Brachytherapy Clinical Applications. The TG was charged with developing

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Polyethylene glycol hydrogel rectal spacer implantation in patients with prostate cancer undergoing combination high-dose-rate brachytherapy and external beam radiotherapy

Cited by 31 publications

References 13 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

High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes

AAPM task group report 303 endorsed by the ABS: MRI implementation in HDR brachytherapy—Considerations from simulation to treatment

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