eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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6/2021
vol. 13
 
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abstract:
Original paper

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

Yuan-Hong Lin
1
,
Wee Loon
1
,
Mark Tacey
1, 2
,
Damien Bolton
3
,
Alwin Tan
4
,
Yee Chan
3
,
Chee Wee Cham
4
,
Huong Ho
5
,
Mario Guerrieri
5
,
Farshad Foroudi
1
,
Daryl Lim Joon
1
,
Kevin McMillan
6
,
George Koufogiannis
6
,
Paul Manohar
6
,
Madalena Liu
6
,
Trung Pham
6
,
Michael Chao
1, 5

1.
Department of Radiation Oncology, Austin Health, Heidelberg, Australia
2.
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
3.
Department of Urology, Austin Health, Heidelberg, Australia, 4The Bays Hospital, Mornington, Australia
4.
The Bays Hospital, Mornington, Australia
5.
Genesis Cancer Care Victoria, Ringwood East, Australia
6.
Ringwood Private Hospital, Ringwood East, Australia
J Contemp Brachytherapy 2021; 13, 6: 605–614
Online publish date: 2021/12/30
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Introduction
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 RV100 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 D1cc and D2cc 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 D20, D5, and D1. 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.

keywords:

low-dose-rate brachytherapy, prostate cancer, rectal spacer, rectal toxicity, rectal dosimetry

 
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