Optimization of prostate brachytherapy techniques with polyethylene glycol–based hydrogel spacers: A systematic review

Ardekani, Mahdieh Afkhami; Ghaffari, Hamed

doi:10.1016/j.brachy.2019.08.009

Cited by 26 publications

(21 citation statements)

References 42 publications

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“…Several systematic reviews have provided qualitative evaluations of different perirectal spacer materials delivered prior to prostate RT, [5][6][7] yet quantitative synthesis of clinical results with specific spacers is limited, to our knowledge. One method to reduce rectal toxic effects involves an absorbable polyethylene glycol hydrogel spacer (SpaceOAR; Boston Scientific), which is injected between the Denonvilliers fascia and anterior rectal wall prior to RT.…”

Section: Introductionmentioning

confidence: 99%

Association of the Placement of a Perirectal Hydrogel Spacer With the Clinical Outcomes of Men Receiving Radiotherapy for Prostate Cancer

et al. 2020

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IMPORTANCE Perirectal spacers are intended to lower the risk of rectal toxic effects associated with prostate radiotherapy. A quantitative synthesis of typical clinical results with specific perirectal spacers is limited. OBJECTIVE To evaluate the association between perirectal hydrogel spacer placement and clinical outcomes of men receiving radiotherapy for prostate cancer. DATA SOURCES A systematic search was performed of the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for articles published through September 2019.STUDY SELECTION Studies comparing men who received a hydrogel spacer vs men who did not receive a spacer (controls) prior to prostate radiotherapy. DATA EXTRACTION AND SYNTHESISVia random-effects meta-analysis, group comparisons were reported using the weighted mean difference for continuous measures and the risk ratio for binary measures. MAIN OUTCOMES AND MEASURESProcedural results, the percentage volume of rectum receiving at least 70 Gy radiation (v70), early (Յ3 months) and late (>3 months) rectal toxic effects, and early and late changes in bowel-related quality of life on the Expanded Prostate Cancer Index Composite (minimal clinically important difference, 4 points). RESULTSThe review included 7 studies (1 randomized clinical trial and 6 cohort studies) involving 1011 men (486 who received a hydrogel spacer and 525 controls), with a median duration of patient follow-up of 26 months (range, 3-63 months). The success rate of hydrogel spacer placement was 97.0% (95% CI, 94.4%-98.8% [5 studies]), and the weighted mean perirectal separation distance was 11.2 mm (95% CI, 10.1-12.3 mm [5 studies]). Procedural complications were mild and transient, occurring in 0% to 10% of patients within the studies. The hydrogel spacer group received 66% less v70 rectal irradiation compared with controls (3.5% vs 10.4%; mean difference, −6.5%; 95% CI, -10.5% to -2.5%; P = .001 [6 studies]). The risk of grade 2 or higher rectal toxic effects was comparable between groups in early follow-up (4.5% in hydrogel spacer group vs 4.1% in control group; risk ratio, 0.82; 95% CI, 0.52-1.28; P = .38 [6 studies]) but was 77% lower in the hydrogel spacer group in late follow-up (1.5% vs 5.7%; risk ratio, 0.23; 95% CI, 0.06-0.99; P = .05 [4 studies]).Changes in bowel-related quality of life were comparable between groups in early follow-up (mean difference, 0.2; 95% CI, -3.1 to 3.4; P = .92 [2 studies]) but were greater in the hydrogel spacer group in late follow-up (mean difference, 5.4; 95% CI, 2.8-8.0; P < .001 [2 studies]).

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Section: Introductionmentioning

confidence: 99%

Association of the Placement of a Perirectal Hydrogel Spacer With the Clinical Outcomes of Men Receiving Radiotherapy for Prostate Cancer

et al. 2020

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“…С учетом последних тенденций по локальной эскалации дозы под этот критерий попадает подавляющее большинство клинических сценариев радиотерапии РПЖ (конформная ДЛТ в режиме стандартного фракционирования и умеренного гипофракционирования, стереотаксическая лучевая терапия (СТЛТ), протонная лучевая терапия, высоко-и низкомощностная брахитерапия). В настоящее время опубликованы данные, свидетельствующие о преимуществах промежностного введения БДС при всех современных технологиях облучения ПЖ [23,[31][32][33][34].…”

Section: методика применения спейсеров и их характеристикаunclassified

Technologies to reduce radiation toxicity in prostate cancer patients: spacers - a simple and effective solution

Novikov

Новиков

2021

Onkourologiâ

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The basic principles of the treatment of prostate cancer patients have underwent significant revisions in recent years. Modern radiotherapy techniques, which have demonstrated high efficacy and safety in long-term randomized trials, are beginning to take a leading position in the treatment of prostate cancer in an overwhelming number of clinical scenarios (National Comprehensive Cancer Network, 2021). Despite the obvious successes of radiation oncology, a number of important problems remain unresolved, first of all - the need to reduce the rates of radiation complications. The topographical anatomy of the prostate gland determines the main profiles of post-radiation damage: rectal and genitourinary radiation toxicity. The previous five years have been marked by a significant intensification of research work abroad aimed at clinical testing of a number of biopolymer compositions and products for use as spacers between irradiated structures and normal tissues. The experience has made it possible for the first time to consider the possibility of using spacers in radiotherapy treatment of prostate cancer in the modern recommendations of the European Association of Urology (2021). The analysis of the national literature shows a complete lack of publications on the possibilities of optimizing the radiation treatment of prostate cancer through the use of specers. The purpose of this work was the need to highlight this important and perspective clinical problem.

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“…It has been shown that rectal spacer devices (endorectal balloons, biodegradable balloons or hydrogel spacers) can help stabilise the prostate during local therapy, by increasing the space between Denonvillier's fascia and the rectal wall, thereby decreasing radiation exposure 13,14 …”

Section: Introductionmentioning

confidence: 99%

“…SpaceOAR hydrogel is the most widely studied rectal spacer, which maintains a stable separation between the prostate and rectum for up to 12 weeks, before hydrolysis, absorption and renal excretion 13‐15 . In the prospective pivotal phase III study, 222 patients with T1‐2 prostate cancer were randomised to SpaceOAR or no spacer during treatment with IMRT; there was a 74% reduction in rectal radiation dose 15 .…”

Section: Introductionmentioning

confidence: 99%

Rectal spacers in patients with prostate cancer undergoing radiotherapy: A survey of UK uro‐oncologists

et al. 2021

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Radical radiotherapy and brachytherapy are recommended in guidelines for the management of patients with localised or locally advanced prostate cancer. 1,2 However, the prostate is a mobile structure, 3 which means that movement during focal treatments can increase the field of exposure, including the rectum and bladder, resulting in potentially serious toxicities.Bowel toxicities include urgency, loose stools, increased frequency of bowel movements, rectal bleeding and faecal incontinence, which can all impact patients' lives. 4 According to the 2020 National Prostate Cancer Audit in England and Wales, 11% of men who had received radical radiotherapy experienced severe bowel toxicity within 2 years of treatment. 5 Additionally, published studies have reported rates of late grade 2 or worse bowel toxicity following intensity-modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT), including hypofractionation regimens, of between 1% and 14%. 6-10 Brachytherapy boost with external beam radiation therapy (EBRT) increases the rate of late genitourinary and gastrointestinal adverse effects compared with EBRT alone. 11,12 It has been shown that rectal spacer devices (endorectal balloons, biodegradable balloons or hydrogel spacers) can help stabilise the prostate during local therapy, by increasing the space between Denonvillier's fascia and the rectal wall, thereby decreasing radiation exposure. 13,14 SpaceOAR hydrogel is the most widely studied rectal spacer, which maintains a stable separation between the prostate and rectum for up to 12 weeks, before hydrolysis, absorption and renal excretion. [13][14][15] In the prospective pivotal phase III study, 222 patients with T1-2 prostate cancer were randomised to SpaceOAR or no spacer during treatment with IMRT; there was a 74% reduction in rectal radiation dose. 15 Although acute (3-month) grade 2 or worse rectal toxicity was reported by approximately 4% of patients in both groups, after a median follow-up of 37 months, grade 2 or above rectal toxicity was reported in 6% of patients in the control arm and none in the SpaceOAR arm. 16 However, several retrospective

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Optimization of prostate brachytherapy techniques with polyethylene glycol–based hydrogel spacers: A systematic review

Cited by 26 publications

References 42 publications

Association of the Placement of a Perirectal Hydrogel Spacer With the Clinical Outcomes of Men Receiving Radiotherapy for Prostate Cancer

Association of the Placement of a Perirectal Hydrogel Spacer With the Clinical Outcomes of Men Receiving Radiotherapy for Prostate Cancer

Technologies to reduce radiation toxicity in prostate cancer patients: spacers - a simple and effective solution

Rectal spacers in patients with prostate cancer undergoing radiotherapy: A survey of UK uro‐oncologists

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