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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 10
Case report

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

Michael Trager, Benjamin Greenberger, Amy S Harrison, James Keller, Robert B Den

J Contemp Brachytherapy 2018; 10, 6: 577–582
Online publish date: 2018/12/28
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High-dose-rate (HDR) brachytherapy is an attractive option for patients receiving definitive radiation therapy for prostate cancer with decreased overall dose to the pelvis. However, ulcerative colitis increases rectal toxicity risk and may be a contraindication. A synthetic hydrogel, SpaceOAR (Augmentix Inc., Waltham, MA, USA), can facilitate the use of HDR brachytherapy for patients where rectal toxicity is a limiting factor.

SpaceOAR gel (13.19 cc) was utilized in a monotherapy HDR prostate treatment with Ir-192 under transrectal ultrasound guidance, with the intention of decreasing rectal dose. SpaceOAR gel was inserted transperineally into the patient 18 days prior to the procedure.

The HDR brachytherapy procedure was tolerated without incident. All planning constraints were met, and the following dosimetry was achieved: Prostate – V100% = 97.3%, V150% = 35%, V200% = 14.5%; Urethra – V118% = 0%; Rectum – D2 cc = 51.6%, V75% = 0 cc. The rectum-catheter spacing was on average between 6-8 mm. Average spacing for our 10 most recent patients without SpaceOAR was 3 mm. SpaceOAR did not hinder or distort ultrasound imaging or increase treatment time.

SpaceOAR successfully increases catheter-rectal wall spacing and decreases rectal dose due to improved planning capabilities, while decreasing the likelihood of rectal perforation. One application of this tool is presented to mitigate potential toxicities associated with ulcerative colitis. At five months, one week, and one day follow-up, the patient reported no bowel issues following HDR brachytherapy.

HDR brachytherapy, HDR, interstitial, prostate HDR, SpaceOAR

Litwin MS, Tan HJ. The diagnosis and treatment of prostate cancer. JAMA 2017; 317: 2532-2542.
Hamdy FC, Donovan JL, Lane JA et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016; 375: 1415-1424.
Michalski JM, Gay H, Jackson A et al. Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys 2010; 76 (Suppl 3): S123-129.
Stenmark MH, Conlon ASC, Johnson S et al. Dose to the inferior rectum is strongly associated with patient reported bowel quality of life after radiation therapy for prostate cancer. Radiother Oncol 2014; 110: 291-297.
Arcangeli G, Fowler J, Gomellini S et al. Acute and late toxicity in a randomized trial of conventional versus hypofractionated three-dimensional conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2011; 79: 1013-1021.
Willett CG, Ooi CJ, Zietman AL et al. Acute and late toxicity of patients with inflammatory bowel disease undergoing irradiation for abdominal and pelvic neoplasms. Int J Radiat Oncol Biol Phys 2000; 46: 995-998.
Murphy CT, Heller S, Ruth K et al. Evaluating toxicity from definitive radiation therapy for prostate cancer in men with inflammatory bowel disease: Patient selection and dosimetric parameters with modern treatment techniques. Pract Radiat Oncol 2015; 5: e215-222.
Annede P, Seisen T, Klotz C et al. Inflammatory bowel diseases activity in patients undergoing pelvic radiation therapy. J Gastrointest Oncol 2017; 8: 173-179.
Song DY, Lawrie WT, Abrams RA et al. Acute and late radiotherapy toxicity in patients with inflammatory bowel disease. Int J Radiat Oncol Biol Phys 2001; 51: 455-459.
Kuban DA, Tucker SL, Dong L et al. Long-term results of the M. D. Anderson Randomized Dose-Escalation Trial for Prostate Cancer. Int J Radiat Oncol Biol Phys 2008; 70: 67-74.
Zietman AL, Bae K, Slater JD et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: Long-term results from Proton Radiation Oncology Group/American College of Radiology 95-09. J Clin Oncol 2010; 28: 1106-1111.
Al-Mamgani A, Heemsbergen WD, Peeters STH et al. Role of intensity-modulated radiotherapy in reducing toxicity in dose escalation for localized prostate cancer. Int J Radiat Oncol Biol Phys 2009; 73: 685-691.
Eade TN, Hanlon AL, Horwitz EM et al. What dose of external-beam radiation is high enough for prostate cancer? Int J Radiat Oncol Biol Phys 2007; 68: 682-689.
Peeters STH, Heemsbergen WD, Koper PCM et al. Dose-response in radiotherapy for localized prostate cancer: Results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol 2006; 24: 1990-1996.
Beckendorf V, Guerif S, Le Prisé E et al. 70 Gy versus 80 Gy in localized prostate cancer: 5-year results of GETUG 06 randomized trial. Int J Radiat Oncol Biol Phys 2011; 80: 1056-1063.
Loblaw A, Liu S, Cheung P. Stereotactic ablative body radiotherapy in patients with prostate cancer. Transl Androl Urol 2018; 7: 330-340.
Lee WR, Koontz BF. Moderate hypofractionation for prostate cancer. Transl Androl Urol 2018; 7: 321-329.
King CR, Brooks JD, Gill H et al. Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer. Int J Radiat Oncol Biol Phys 2012; 82: 877-882.
Arcangeli G, Saracino B, Gomellini S et al. A prospective phase III randomized trial of hypofractionation versus conventional fractionation in patients with high-risk prostate cancer. Int J Radiat Oncol Biol Phys 2010; 78: 11-18.
Mahal AR, Yu JB. Current and emerging standards in radiation therapy for prostate cancer. Am J Hematol Oncol 2017; 13: 11-15.
Lee WR, Dignam JJ, Amin MB et al. Randomized phase III noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer. J Clin Oncol 2016; 34: 2325-2332.
Skowronek J. Brachytherapy in the therapy of prostate cancer – an interesting choice. Contemp Oncol 2013; 7: 407-412.
Mendez LC, Morton GC. High dose-rate brachytherapy in the treatment of prostate cancer. Transl Androl Urol 2018; 7: 357-370.
Georg D, Hopfgartner J, Gòra J et al. Dosimetric considerations to determine the optimal technique for localized prostate cancer among external photon, proton, or carbon-ion therapy and high-dose-rate or low-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 2014; 88: 7157-7122.
Tisseverasinghe SA, Crook JM. The role of salvage brachytherapy for local relapse after external beam radiotherapy for prostate cancer. Transl Androl Urol 2018; 7: 414-435.
Rodda S, Tyldesley S, Morris WJ et al. ASCENDE-RT: An analysis of treatment-related morbidity for a randomized trial comparing a low-dose-rate brachytherapy boost with a dose-escalated external beam boost for high- and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys 2017; 98: 286-295.
Krauss DJ, Ye H, Martinez AA et al. Favorable preliminary outcomes for men with low- and intermediate-risk prostate cancer treated with 19-Gy single-fraction high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 2017; 97: 98-106.
Prada PJ, Cardenal J, García A et al. High-dose-rate interstitial brachytherapy as monotherapy in one fraction for the treatment of favorable stage prostate cancer: Toxicity and long-term biochemical results. Radiother Oncol 2016; 119: 411-416.
Tang Q, Zhao F, Yu X et al. The role of radioprotective spacers in clinical practice: a review. Quant Imaging Med Surg 2018; 8: 514-524.
Mariados N, Sylvester J, Shah D et al. Hydrogel spacer prospective multicenter randomized controlled pivotal trial: dosimetric and clinical effects of perirectal spacer application in men undergoing prostate image guided intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 2015; 92: 971-977.
Ruciński A, Bauer J, Campbell P et al. Preclinical investigations towards the first spacer gel application in prostate cancer treatment during particle therapy at HIT. Radiat Oncol 2013; 8: 134.
Van Wijk Y, Vanneste BGL, Jochems A et al. Development of an isotoxic decision support system integrating genetic markers of toxicity for the implantation of a rectum spacer. Acta Oncol (Madr) 2018; 57: 1499-1505.
Hamstra DA, Mariados N, Sylvester J et al. Continued benefit to rectal separation for prostate radiation therapy: final results of a phase III trial. Int J Radiat Oncol Biol Phys 2017; 97: 976-985.
Karsh LI, Gross ET, Pieczonka CM et al. Absorbable hydrogel spacer use in prostate radiotherapy: a comprehensive review of phase 3 clinical trial published data. Urology 2018; 115: 39-44.
Prada PJ, Jimenez I, Gonz H et al. High-dose-rate interstitial brachytherapy as monotherapy in one fraction and transperineal hyaluronic acid injection into the perirectal fat for the treatment of favorable stage prostate cancer: Treatment description and preliminary results. Brachytherapy 2012; 11: 105-110.
Strom TJ, Wilder RB, Fernandez DC et al. Prostate radiotherapy A dosimetric study of polyethylene glycol hydrogel in 200 prostate cancer patients treated with high-dose rate brachytherapy ± intensity modulated radiation therapy. Radiother Oncol 2014; 111: 126-131.
Yeh J, Lehrich B, Tran C et al. Polyethylene glycol hydrogel rectal spacer implantation in patients with prostate cancer undergoing combination high-dose-rate brachytherapy and external beam radiotherapy. Brachytherapy 2016; 15: 283-287.
Van Gysen K, Kneebone A, Alfieri F et al. Feasibility of and rectal dosimetry improvement with the use of SpaceOAR® hydrogel for dose-escalated prostate cancer radiotherapy. J Med Imaging Radiat Oncol 2014; 58: 511-516.
Hedrick SG, Fagundes M, Case S et al. Validation of rectal sparing throughout the course of proton therapy treatment in prostate cancer patients treated with SpaceOAR®. J Appl Clin Med Phys 2017; 18: 82-89.
Williams NL, Rivera A, Hardin MT et al. Phase 1 study of high-dose-rate brachytherapy combined with hypofractionated volumetric modulated arc therapy for intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys 2015; 93: e207.
Hoskin PJ, Colombo A, Henry A et al. GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: An update. Radiother Oncol 2013; 107: 325-332.
Brenner DJ. Fractionation and late rectal toxicity. Int J Radiat Oncol Biol Phys 2004; 60: 1013-1015.
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