MRI findings of absorbable hydrogel spacer for prostate cancer therapy: a pictorial review

Rohr, Aaron; Werth, Kyle; Collins, Zachary; Fishback, Shelby; Jones, Jill K.; Ash, Ryan; Williams, Vanessa

doi:10.1007/s00261-018-1685-y

Cited by 5 publications

(2 citation statements)

References 9 publications

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“…A previous pictorial review of MRI findings evaluated post-hydrogel injection pitfalls such as asymmetry, rectal wall infiltration, and prostate subcapsular injection. 16 In this paper, we learned about the MRI findings of hydrogel post-injection and evaluated MRI findings of hydrogel spacer post-injection. Previous studies might not have adequately evaluated complications due to a lack of knowledge regarding MRI of hydrogel post-injection.…”

Section: Discussionmentioning

confidence: 99%

“…Asymmetry also results in rectal wall infiltration 15 . According to a previous pictorial review, other post‐injection pitfalls included rectal wall infiltration and prostate subcapsular injection 16 . Thus, although many reports have demonstrated the usefulness of the spacer, complications associated with its placement remain a major concern.…”

Section: Introductionmentioning

confidence: 99%

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Safety of hydrogel spacers for rectal wall protection in patients with prostate cancer: A retrospective analysis of 200 consecutive cases

et al. 2023

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Objective To evaluate the safety and complications of hydrogel spacer implantation. Methods This single‐center historical cohort study retrospectively analyzed cases of hydrogel spacer implantation between October 2018 and March 2022. The survey items were the rates of possible hydrogel injection implementation, the success rate of hydrogel implantation including asymmetry, higher position, rectal wall infiltration, subcapsular injection, and other adverse events, and width created by the spacer. To investigate the learning curve, 1, 2, and 3 points were assigned to adverse event grades G1, G2, and G3, respectively. Spacer effectiveness obstruction, such as asymmetry was assigned 3 points. A Mann–Whitney U test was performed to assess statistically significant differences. Results The study included a total of 200 patients with a median (range) age of 70 (44–85) years. In 10 (5%) patients, hydrogel injection implementation was not possible. Of 190 patients who underwent hydrogel spacer placement, 168 (88%) received a satisfactory placement. The median (range) width of hydrogel spacers was 13.1 (4.4–18.7) mm. Spacer asymmetry, higher position, rectal wall infiltration, and prostate subcapsular infiltration occurred in 7 (3.7%), 5 (2.6%), 12 (6.3%), and 1 (0.5%) patients, respectively. G1 and G3 adverse events occurred in 13 (7%) and 4 (2%) patients, respectively. Practitioner #1 who performed the highest number of procedures had significantly (p = 0.04) lower total scores in group B. Conclusion Spacer implantation yielded favorable outcomes with a high percentage of appropriate spacer implantation, and few major complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety of hydrogel spacers for rectal wall protection in patients with prostate cancer: A retrospective analysis of 200 consecutive cases

et al. 2023

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Rectal perforation following SpaceOAR placement combined with permanent prostate brachytherapy

Morita,

Tanabe,

Kinugawa

et al. 2024

IJU Case Reports

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IntroductionWe report a case of rectal perforation following SpaceOAR placement utilized with iodine‐125 low‐dose‐rate brachytherapy for prostate cancer.Case presentationA 65‐year‐old patient with localized prostate cancer underwent SpaceOAR placement following LDR‐BT. No significant issues occurred with the SpaceOAR procedure, and no abnormalities were found on the next day's T2‐weighted magnetic resonance imaging. Two weeks later, a colonoscopy was performed due to mucus stools revealing rectal perforation attributed to SpaceOAR. By maintaining Macrogol 4000 and a low residue diet, the perforation healed within 6 months.ConclusionRectal ulcers and perforations are the most common severe adverse events from SpaceOAR placement. Effective management strategies are crucial since complications can't be entirely avoided, even with skilled surgeons.

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Unexpected change in hydrogel spacer volume during external-beam radiation therapy

Ishibashi,

Hata,

Fujikawa

et al. 2024

Jpn J Radiol

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Purpose To reduce the rectal radiation dose during local radiation therapy of prostate cancer, a hydrogel spacer is typically implanted between the prostate and rectum. However, the spacer volume can change during external beam radiation therapy (EBRT). Therefore, we used magnetic resonance imaging (MRI) to determine changes in the spacer volume during EBRT and analyzed the data to identify patient factors influencing this change. Materials and methods A hydrogel spacer was implanted in each enrolled patient diagnosed with prostate cancer (n = 22, age = 69–86 years) for EBRT with a total dose of 70 Gy over 35 fractions. T2-weighted MRI images were acquired before (median = 8 days) and during EBRT, when the radiation dose of 48 Gy (median) was given at 55 days (median) after implantation. MRI images were used to determine the spacer volume as well as the maximum and minimum distances between the prostate and anterior wall of the rectum at the middle height of the prostate. Scatterplots were created to determine whether correlations existed between changes in the spacer volume and these two distances, while uni- and multivariate analyses were conducted to determine if the spacer volume change was influenced by the following patient factors: age, body mass index, estimated glomerular filtration rate, and visceral fat areas at the umbilical and femoral head positions. Results The spacer volume increased in all 22 patients, with the smaller spacer volume before EBRT increasing by a larger amount during EBRT. This increase in the spacer volume was unaffected by other patient factors. However, it correlated with the change in the maximum distance between the prostate and anterior wall of the rectum. Conclusion To avoid adverse changes in the rectal radiation dose during EBRT, hydrogel spacer volume should be monitored, especially if the pre-EBRT volume is small.

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MRI findings of absorbable hydrogel spacer for prostate cancer therapy: a pictorial review

Cited by 5 publications

References 9 publications

Safety of hydrogel spacers for rectal wall protection in patients with prostate cancer: A retrospective analysis of 200 consecutive cases

Safety of hydrogel spacers for rectal wall protection in patients with prostate cancer: A retrospective analysis of 200 consecutive cases

Rectal perforation following SpaceOAR placement combined with permanent prostate brachytherapy

Unexpected change in hydrogel spacer volume during external-beam radiation therapy

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