Transperineal Injection of Hyaluronic Acid in Anterior Perirectal Fat to Decrease Rectal Toxicity From Radiation Delivered With Intensity Modulated Brachytherapy or EBRT for Prostate Cancer Patients

Management of Complications of Prostate Cancer Treatment

“…95 A recent study promotes injection of hyaluronic acid as a spacer between prostate and rectal wall to reduce rectal dose and hopefully mitigate side effects. 96 Diarrhea can be effectively managed with antidiarrheal agents such as loperamide (Imodium), while proctitis and urgency are often effectively treated with dietary modification and/or psyllium (Metamucil) to add increased bulk. For those patients with significant rectal irritation, cramping, and tenesmus, steroid suppositories may provide relief.…”

High-Dose-Rate Interstitial Brachytherapy as Monotherapy in One Fraction for the Treatment of Favorable Stage Prostate Cancer

“…We believe that the increase in distance between rectum and posterior prostatic capsule created by the peri-rectal injection of hyaluronic acid is enough to provide a significant radiation dose reduction from HDR brachytherapy and have significantly smaller incidence of mucosal damage [11,12].…”

“…We believe that the increase in distance (mean 2 cm along the length of the prostate) will be enough to provide a significant radiation dose reduction from HDR brachytherapy [11,12].…”

Neurovascular Bundle Infiltration Can Explain Local Relapses Using Conformal Radiotherapy of Prostate Cancer

“…The disadvantage of a larger CTV is an increased dose to the rectum. By separating the rectum from the prostate using rectum spacers (26)(27)(28)(29)(30)(31), the dose to the rectum will be lowered. This will be even more important when using small margins and very conformal techniques such as VMAT and proton therapy.…”