Cross-linked hyaluronan gel improves the quality of life of prostate cancer patients undergoing radiotherapy

Wilder, Richard B.; Barme, Greg; Gilbert, Ronald F.; Holevas, Richard E.; Kobashi, Luis I.; Reed, Richard R.; Solomon, Ronald S.; Walter, Nancy L.; Chittenden, Lucy; Mesa, Albert; Agustin, Jeffrey; Lizarde, Jessica; Macedo, Jorge C.; Ravera, John; Tokita, Kenneth

doi:10.1016/j.brachy.2009.12.005

Cited by 24 publications

(12 citation statements)

References 57 publications

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“…These data could be confirmed by other authors in clinical use during EBRT demonstrating a dose reduction to the anterior rectal wall by 50% [21]. This was associated with decreased risk for acute rectal toxicity compared with historical control [22] and improved quality of life [24]. Even for BT Prada et al [22] could demonstrate that measured rectal dose for HDR boost was significantly lower by about 2 Gy in prostate cancer patients.…”

Section: Discussionsupporting

confidence: 55%

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Rectum separation in patients with cervical cancer for treatment planning in primary chemo-radiation

et al. 2012

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PurposeTo proof feasibility of hydrogel application in patients with advanced cervical cancer undergoing chemo-radiation in order to reduce rectal toxicity from external beam radiation as well as brachytherapy.Material and methodsUnder transrectal sonographic guidance five patients with proven cervical cancer underwent hydro gel (20 cc) instillation into the tip of rectovaginal septum adherent to posterior part of the visible cervical tumor. Five days after this procedure all patients underwent T2 weighted transversal and sagittal MRI for brachytherapy planning. MRI protocol included T2 weighted fast spin echo (FSE) imaging in sagittal, coronal and para-axial orientation using an 1.5 Tesla MRI. Separation of anterior rectal wall and cervix was documented.ResultsHydrogel application was uneventful in all patients and no toxicity was reported. Separation ranged from 7 to 26 mm in width (median 10 mm). The length of the separation varied between 18 and 38 mm (median 32 mm). In all patients displacement was seen in the posterior vaginal fornix, and/or at the deepest part of uterine cervix depending on the extension of the cul-de-sac in correlation to the posterior wall of the uterus. In patients with bulky tumor and/or deep (vaginal) extend of peritoneal cavity tumour was seen mainly cranial from the rectovaginal space and therefore above the hydrogeI application. Only in the extra-peritoneal (lower) part of the cervix a good separation could be achieved between the rectum and cervix.ConclusionHydrgel instillation in patients with cervial cancer undergoing chemoradiation is safe and feasible. Because of the loose tissue of the cul-de-sac and its intra- and extraperitoneal part, hydrogel instillation of 20 cc did not result in a sufficient separation of the cervix from anterior wall.

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Section: Discussionsupporting

confidence: 55%

“…Injection of human collagen into the space between prostate and rectum in prostate cancer patients have shown decline of rectal dose by 25%–50% [20-24]. Therefore this new technique was thought to be an interesting option even for patients with cervical carcinoma undergoing EBRT and BT.…”

Section: Introductionmentioning

confidence: 99%

Rectum separation in patients with cervical cancer for treatment planning in primary chemo-radiation

et al. 2012

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“…However more patients in the spacer group were bothered by uncontrolled bowel movements, which might be caused due to irritation of the anal sphincter. (Wilder et al 2011) were able to demonstrate decreased bowel bother scores in patients receiving hyalform spacer in 35 patients receiving intensity-modulated radiotherapy and high-dose rate brachytherapy compared to a control group of 5 patients without hyalform. Within a multi-institutional phase II trial 52 patients received IMRT (78 Gy) after injection of an absorbable hydrogel (Uhl et al 2013).…”

Section: Reproducibility/stability and Radioprotection Of The Rectum/mentioning

confidence: 94%

“…Whereas, a control group of 239 patients receiving the same treatment without rectal spacer reported 2.5 % Grade C2 acute diarrhea. The mean rectal IMRT doses per fraction were reduced from 1.05 to 0.74 Gy with hyalform (Wilder et al 2011). Hatiboglu et al (2012) analyzed 27 patients receiving hydrogel injection with regard to space creation, stability of spacer, duration of procedure, and reduction of rectal dose for prostate cancer patients receiving IMRT up to 78 Gy.…”

Section: Reproducibility/stability and Radioprotection Of The Rectum/mentioning

confidence: 99%

Internal Immobilization: From Rectal Balloon to Hyaluronic Acid

Goldner

2013

Radiotherapy in Prostate Cancer

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“…A novel concept consisting of the use of a tissue spacer to displace the anterior rectal wall away from the prostate has been shown to be feasible and to remain stable during the course of treatment, with the advantage of significantly decreasing rectal irradiation 10, 11, 12, 13, 14, 15. In a multicenter trial, high dose rectal sparing with hydrogel spacer for patients undergoing IMRT was associated with reduced rectal toxicity severity and improved bowel quality of life scores 16.…”

Section: Introductionmentioning

confidence: 99%

Validation of rectal sparing throughout the course of proton therapy treatment in prostate cancer patients treated with SpaceOAR^®

Hedrick

Fagundes

Case

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to investigate the consistency of rectal sparing using multiple periodic quality assurance computerized tomography imaging scans (QACT) obtained during the course of proton therapy for patients with prostate cancer treated with a hydrogel spacer. Forty‐one low‐ and intermediate‐risk prostate cancer patients treated with image‐guided proton therapy with rectal spacer hydrogel were analyzed. To assess the reproducibility of rectal sparing with the hydrogel spacer, three to four QACTs were performed for each patient on day 1 and during weeks 1, 3, and 5 of treatment. The treatment plan was calculated on the QACT and the rectum V90%, V75%, V65%, V50%, and V40% were evaluated. For the retrospective analysis, we evaluated each QACT and compared it to the corresponding treatment planning CT (TPCT), to determine the average change in rectum DVH points. We were also interested in how many patients exceeded an upper rectum V90% threshold on a QACT. Finally, we were interested in a correlation between rectum volume and V90%. On each QACT, if the rectum V90% exceeded the upper threshold of 6%, the attending physician was notified and the patient was typically prescribed additional stool softeners or laxatives and reminded of dietary compliance. In all cases of the rectum V90% exceeding the threshold, the patient had increased gas and/or stool, compared to the TPCT. On average, the rectum V90% calculated on the QACT was 0.81% higher than that calculated on the TPCT. The average increase in V75%, V65%, V50%, and V40% on the QACT was 1.38%, 1.59%, 1.87%, and 2.17%, respectively. The rectum V90% was within ± 1% of the treatment planning dose in 71.2% of the QACTs, and within ± 5% in 93.2% of the QACTs. The 6% threshold for rectum V90% was exceeded in 7 out of 144 QACTs (4.8%), identified in 5 of the 41 patients. We evaluated the average rectum V90% across all QACTs for each of these patients, and it was found that the rectum V90% never exceeded 6%. 53% of the QACTs had a rectum volume within 5 cm3 of the TPCT volume, 68% were within 10 cm3. We found that patients who exceeded the threshold on one or more QACTs had a lower TPCT rectal volume than the overall average. By extrapolating patient anatomy from three to four QACT scans, we have shown that the use of hydrogel in conjunction with our patient diet program and use of stool softeners is effective in achieving consistent rectal sparing in patients undergoing proton therapy.

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Cross-linked hyaluronan gel improves the quality of life of prostate cancer patients undergoing radiotherapy

Cited by 24 publications

References 57 publications

Rectum separation in patients with cervical cancer for treatment planning in primary chemo-radiation

Rectum separation in patients with cervical cancer for treatment planning in primary chemo-radiation

Internal Immobilization: From Rectal Balloon to Hyaluronic Acid

Validation of rectal sparing throughout the course of proton therapy treatment in prostate cancer patients treated with SpaceOAR^®

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Cross-linked hyaluronan gel improves the quality of life of prostate cancer patients undergoing radiotherapy

Cited by 24 publications

References 57 publications

Rectum separation in patients with cervical cancer for treatment planning in primary chemo-radiation

Rectum separation in patients with cervical cancer for treatment planning in primary chemo-radiation

Internal Immobilization: From Rectal Balloon to Hyaluronic Acid

Validation of rectal sparing throughout the course of proton therapy treatment in prostate cancer patients treated with SpaceOAR®

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Product

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Validation of rectal sparing throughout the course of proton therapy treatment in prostate cancer patients treated with SpaceOAR^®