SpaceOAR to improve dosimetric outcomes for monotherapy high-dose-rate prostate implantation in a patient with ulcerative colitis

Träger, M.; Greenberger, Benjamin A.; Harrison, A; Keller, James M.; Den, Robert B.

doi:10.5114/jcb.2018.81001

Cited by 5 publications

(3 citation statements)

References 41 publications

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“…37,38 Interestingly, there have been a few case reports of IBD patients achieving successful oncologic outcomes with minimal IBD flare-ups from prostate cancer radiotherapy after SpaceOAR placement. [39][40][41] These case reports suggest that the IBD patients with localized prostate cancer may be viable candidates for radiotherapy after SpaceOAR placement.…”

Section: Discussionmentioning

confidence: 80%

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: 80%

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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“…focused on patients treated with LDR-BT or HDR-BT also demonstrated a reduction in acute and late GI toxicities post-HS insertion [ 25 ]. Furthermore, several other research have also reported significant reduction in acute and late rectal toxicities post-RS insertion in LDR-BT as monotherapy, or as combination therapy [ 13 , 45 , 46 , 53 ] in HDR-BT [ 25 , 32 , 35 , 37 , 54 , 55 ], and particularly in the settings of IMRT in large-scale multi-institutional randomized clinical trial [ 39 - 41 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of hydrogel and hyaluronic acid rectal spacer on rectal dosimetry and toxicity in low-dose-rate prostate brachytherapy: a multi-institutional analysis of patients’ outcomes

Lin¹,

Loon²,

Tacey³

et al. 2021

jcb

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Purpose: To report on rectal dosimetry and toxicity outcomes in men with prostate cancer (PCa) treated with iodine-125 low-dose-rate brachytherapy (LDR-BT) with or without polyethylene glycol hydrogel (HS) or hyaluronic acid (HA) rectal spacer (RS) insertion.Material and methods: Seventy consecutive men treated with LDR-BT between December 2017 and July 2019 were included in this study, including twenty-eight (40%) men who had RS insertion according to the preference of referring urologist, compared to a group of forty-two men (60%) without RS. Descriptive statistics were used to compare RS safety, dosimetric effects on organs at risk (rectum and urethra), and gastrointestinal (GI) and genitourinary toxicities (GU) (assessed using the CTCAE v.4) between the two groups of patients.Results: The median prostate-rectal separation with RS at mid prostate was 10 mm (IQR, 8-11.5 mm). The median follow-up was 23.5 months. There were no post-operative complications for RS insertion. There was significantly reduced rectal dosimetry in RS-group vs. non-RS group; the median RV 100 was 0.0 cc (IQR, 0.0-0.0 cc) vs. 0.4 cc (IQR, 0.1-1.1 cc) (p < 0.001), respectively. The mean rectal D 1cc and D 2cc were 52.4% vs. 84.2% (p < 0.001) and 45.7% vs. 70.0% (p < 0.001) for RS and non-RS group, respectively. There were no statistically significant differences in the mean urethral D 20 , D 5 , and D 1 . There were significantly less grade 1 acute and late GI toxicities in RS-group when compared to non-RS group (0% vs. 24%, p = 0.004 for acute GI toxicity; 4% vs. 33%, p = 0.003 for late GI toxicity). There were no reported acute or late grade 2 or above GI toxicities.Conclusions: Insertion of RS in men treated with LDR-BT is safe and resulted in a significant reduction in rectal dosimetry. The reduction in rectal dosimetry with RS insertion translates into significantly reduced acute and late GI toxicities.

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“…The patient reported no bowel issues following HDR brachytherapy after one day, one week and five months, respectively. [19] Studies seldom investigate rectal spacer placement in previously irradiated prostates. Injection feasibility remains unclear in externally irradiated patients (e.g.…”

Section: Discussionmentioning

confidence: 99%

Hydrogel Spacer may Allow Prostate Re-irradiation even in Patients with Ulcerative Colitis: A Case Report

et al. 2020

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Salvage radiotherapy is a valid option for locally recurrent prostate cancer (PC) patients. Two of the treatment options are as follows: interventional radiotherapy or stereotactic body radiotherapy (SBRT). SBRT has the main advantage as a noninvasive procedure. Synthetic gel injection into the prostate and rectum space, as a novel technique in prostate radiotherapy, spares the anterior rectal wall from a high dose. Inflammatory bowel disease, including Crohn's disease and ulcerative colitis (UC), contraindicate external beam radiotherapy due to increased bowel complication risk. In this study, we describe the first PC patient with UC in remission treated with salvage SBRT and hydrogel rectal spacer. After ten months of follow-up, no bowel symptoms were reported, and SBRT provided both biochemical and clinical response. Even patients with UC and radio-recurrent PC may be viable salvage SBRT candidates.

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SpaceOAR to improve dosimetric outcomes for monotherapy high-dose-rate prostate implantation in a patient with ulcerative colitis

Cited by 5 publications

References 41 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

Impact of hydrogel and hyaluronic acid rectal spacer on rectal dosimetry and toxicity in low-dose-rate prostate brachytherapy: a multi-institutional analysis of patients’ outcomes

Hydrogel Spacer may Allow Prostate Re-irradiation even in Patients with Ulcerative Colitis: A Case Report

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