Prospective evaluation of a specific technique of sexual function preservation in external beam radiotherapy for prostate cancer

Samlali, H.; Udrescu, C.; Lapierre, A.; Enachescu, C.; Ruffion, A.; Jalade, P.; Chapet, O.

doi:10.1259/bjr.20160877

Cited by 9 publications

(4 citation statements)

References 31 publications

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“…Two single- arm prospective studies on vessel sparing RT appeared to provide improvements in potency and sexual QOL preservation as compared with historical controls ( 25 , 26 ). In contrast, a recent phase 3 trial of IMRT to spare the PB and corporal bodies did not find a difference in potency sparing at 2 years as measured using the international index of erectile function (IIEF) (47.9% experimental vs. 46% control) ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

A pooled long-term follow-up after radiotherapy for prostate cancer with and without a rectal hydrogel spacer: impact of hydrogel on decline in sexual quality of life

Seymour,

Pinkawa,

Daignault-Newton

et al. 2023

Front. Oncol.

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PurposeThe purpose of this study was to analyze the impact of prostate rectal spacers on sexual quality of life (QOL) following external beam radiation therapy (RT).Methods and materialsPatient- reported QOL was evaluated using the Expanded Prostate Cancer Index Composite (EPIC). Patients were pooled from two sources: a randomized controlled trial and a non-randomized cohort of patients from a single institution. Both cohorts used the same spacing product and QOL instrument. Analysis was limited to those with good baseline pre-treatment sexual QOL (EPIC >/= 60). Differences in QOL summary score and individual items were assessed compared with baseline and between treatment arms.ResultsA total of 128 men had good baseline sexual function and were evaluated (64% with spacer and 36% without) with QOL data available for median 33 months (range: 2.5–69.4 months). Men without spacer were more likely to have declines in sexual function (p < 0.0001), bother (p = 0.0002), and sexual summary score (p < 0.0001). A minimally important difference of 10 points (1xMID) and 20 point (2xMID) was more likely without rectal spacer [10 points: odds ratio 3.53, (95% confidence interval 1.11–11.2), p = 0.032; 20 points: odds ratio 3.29, (95% confidence interval 1.16–9.33), p = 0.025]. Seven of 13 QOL items were statistically superior with hydrogel (six of nine functional and one of four bother), while no items were statistically superior for control. At baseline, more men treated with hydrogel had erections sufficient for intercourse; however, when analyzed only by the men with best baseline erectile potential and excluding those with worse function, the benefit of rectal spacing was maintained with a higher likelihood of preservation of erections sufficient for intercourse in those treated with hydrogel.ConclusionIn this pooled analysis of QOL after prostate RT, the utilization of a hydrogel spacer was associated with better sexual QOL, less men with measurable declines in sexual QOL, and higher rates of adequate erectile function.

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Section: Discussionmentioning

confidence: 99%

A pooled long-term follow-up after radiotherapy for prostate cancer with and without a rectal hydrogel spacer: impact of hydrogel on decline in sexual quality of life

Seymour,

Pinkawa,

Daignault-Newton

et al. 2023

Front. Oncol.

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“…Several recent erectile-function preserving radiation approaches conducted with IMRT have sought to spare the internal pudendal artery (IPA) and the adjacent pelvic nerve plexii in an effort to limit RiED. Dosimetric feasibility of IPA sparing has been demonstrated in conventionally fractionated, 20 hypofractionated 22 and SBRT regimens. 29 Only two single-arm series have published clinical RiED outcomes, as discussed earlier.…”

Section: Discussionmentioning

confidence: 99%

“… 18–21 Two prospective vessel-sparing radiotherapy treatment regimens that used MRI-angiogram to delineate and avoid erectile vasculature reported 2-year erectile preservation rates that were higher than historical controls, in the range of 80–90% at 2–5 years. 22,23 …”

Section: Introductionmentioning

confidence: 99%

Dosimetric feasibility of neurovascular bundle-sparing stereotactic body radiotherapy with periprostatic hydrogel spacer for localized prostate cancer to preserve erectile function

Hwang

Mayeda

Shaish

et al. 2021

The British Journal of Radiology

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Objective: We aim to test the hypothesis that neurovascular bundle (NVB) displacement by rectal hydrogel spacer combined with NVB delineation as an organ at risk (OAR) is a feasible method for NVB-sparing stereotactic body radiotherapy. Methods: Thirty-five men with low- and intermediate-risk prostate cancer who underwent rectal hydrogel spacer placement and pre-, post-spacer prostate MRI studies were treated with prostate SBRT (36.25 Gy in five fractions). A prostate radiologist contoured the NVB on both the pre- and post-spacer T2W MRI sequences that were then registered to the CT simulation scan for NVB-sparing radiation treatment planning. Three SBRT treatment plans were developed for each patient: (1) no NVB sparing, (2) NVB-sparing using pre-spacer MRI, and (3) NVB-sparing using post-spacer MRI. NVB dose constraints include maximum dose 36.25 Gy (100%), V34.4 Gy (95% of dose) <60%, V32Gy <70%, V28Gy <90%. Results: Rectal hydrogel spacer placement shifted NVB contours an average of 3.1 ± 3.4 mm away from the prostate, resulting in a 10% decrease in NVB V34.4 Gy in non-NVB-sparing plans (p < 0.01). NVB-sparing treatment planning reduced the NVB V34.4 by 16% without the spacer (p < 0.01) and 25% with spacer (p < 0.001). NVB-sparing did not compromise PTV coverage and OAR endpoints. Conclusions: NVB-sparing SBRT with rectal hydrogel spacer significantly reduces the volume of NVB treated with high-dose radiation. Rectal spacer contributes to this effect through a dosimetrically meaningful displacement of the NVB that may significantly reduce RiED. These results suggest that NVB-sparing SBRT warrants further clinical evaluation. Advances in knowledge: This is a feasibility study showing that the periprostatic NVBs can be spared high doses of radiation during prostate SBRT using a hydrogel spacer and nerve-sparing treatment planning.

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“…Опубликованные результаты свидетельствуют о сохранности ЭФ на приемлемом уровне приблизительно в 90% случаев на протяжении 5 лет после лучевого лечения. Эти данные подтверждены в другом проспективном исследовании [35].…”

Section: механизмы развития радиационноиндуцированной эректильной дисunclassified

Radiation-Induced Erectile Dysfunction in Prostate Cancer Patients: Up-to-Date View on Pathogenesis

Novikov

Protoshchak

et al. 2021

Vestn. rentgenol. radiol.

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The true causes of sexual disorders after radiation treatment of prostate cancer, among which the central role is occupied by erectile dysfunction, are still not fully clarified. The number of patients who undergo various radiation-exposure options as a radical therapy is steadily increasing, which makes the issue very relevant. This literature review provides up-to-date data on the most studied probable mechanisms of the erectile function status decline after radiation therapy for prostate cancer.

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Prospective evaluation of a specific technique of sexual function preservation in external beam radiotherapy for prostate cancer

Cited by 9 publications

References 31 publications

A pooled long-term follow-up after radiotherapy for prostate cancer with and without a rectal hydrogel spacer: impact of hydrogel on decline in sexual quality of life

A pooled long-term follow-up after radiotherapy for prostate cancer with and without a rectal hydrogel spacer: impact of hydrogel on decline in sexual quality of life

Dosimetric feasibility of neurovascular bundle-sparing stereotactic body radiotherapy with periprostatic hydrogel spacer for localized prostate cancer to preserve erectile function

Radiation-Induced Erectile Dysfunction in Prostate Cancer Patients: Up-to-Date View on Pathogenesis

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