Strahlentherapie und Onkologie

, Volume 193, Issue 1, pp 22–28 | Cite as

Hydrogel injection reduces rectal toxicity after radiotherapy for localized prostate cancer

  • Michael Pinkawa
  • Vanessa Berneking
  • Liane König
  • Dilini Frank
  • Marilou Bretgeld
  • Michael J. Eble
Original Article
First Online:
Received:
Accepted:

Abstract

Purpose

Injection of a hydrogel spacer before prostate cancer radiotherapy (RT) is known to reduce the dose to the rectal wall. Clinical results from the patient’s perspective are needed to better assess a possible benefit.

Methods

A group of 167 consecutive patients who received prostate RT during the years 2010 to 2013 with 2‑Gy fractions up to 76 Gy (without hydrogel, n = 66) or 76–80 Gy (with hydrogel, n = 101) were included. The numbers of interventions resulting from bowel problems during the first 2 years after RT were compared. Patients were surveyed prospectively before RT, at the last day of RT, and at a median of 2 and 17 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite).

Results

Baseline patient characteristics were well balanced. Treatment for bowel symptoms (0 vs. 11 %; p < 0.01) and endoscopic examinations (3 vs. 19 %; p < 0.01) were performed less frequently with a spacer. Mean bowel function scores did not change for patients with a spacer in contrast to patients without a spacer (mean decrease of 5 points) >1 year after RT in comparison to baseline, with 0 vs. 12 % reporting a new moderate/big problem with passing stools (p < 0.01). Statistically significant differences were found for the items “loose stools”, “bloody stools”, “painful bowel movements” and “frequency of bowel movements”.

Conclusion

Spacer injection is associated with a significant benefit for patients after prostate cancer RT.

Keywords

Prostate neoplasm Radiotherapy, intensity-modulated Radiotherapy, image-guided Quality of life Questionnaires Spacer 

Hydrogelinjektion vermindert die rektale Toxizität nach Radiotherapie bei lokalisiertem Prostatakarzinom

Zusammenfassung

Ziel

Bei der Radiotherapie (RT) des Prostatakarzinoms kann die Dosis an der Rektumwand durch die Injektion eines Hydrogelabstandhalters gesenkt werden. Klinische Ergebnisse aus der Sicht des Patienten sind zur Einschätzung eines möglichen Vorteils erforderlich.

Methoden

Eine Gruppe von 167 konsekutiven Patienten, die in den Jahren 2010–2013 eine Prostata-RT mit Einzeldosen von 2 bis 76 Gy (ohne Hydrogel, n = 66) bzw. 76–80 Gy (mit Hydrogel, n = 101) erhalten hatten, wurde eingeschlossen. Die Anzahl der wegen Beschwerden beim Stuhlgang resultierenden Interventionen in den ersten 2 Jahren nach RT wurde verglichen. Die Patienten wurden prospektiv vor RT, am letzten Tag der RT sowie im Median 2 Monate und 17 Monate nach RT mit einem validierten Fragebogen befragt (Expanded Prostate Cancer Index Composite).

Ergebnisse

Die Basischarakteristika waren in beiden Gruppen vergleichbar. Die Behandlung von Beschwerden beim Stuhlgang (0 vs. 11 %; p < 0,01) und endoskopische Untersuchungen (3 vs. 19 %; p < 0,01) wurden bei Patienten mit Abstandhalter seltener durchgeführt. Über ein Jahr nach RT änderten sich die durchschnittlichen Punktwerte für die Darmfunktion bei Patienten mit Abstandhalter verglichen mit den Ausgangswerten nicht, im Gegensatz dazu fand sich bei Patienten ohne Abstandhalter ein durchschnittlicher Abfall von 5 Punkten. Bei 0 vs. 12 % trat ein mäßiges/großes Problem durch Beschwerden beim Stuhlgang neu auf (p < 0,01). Statistisch signifikante Unterschiede fanden sich bei den Items „weicher Stuhlgang“, „blutiger Stuhlgang“, „schmerzhafter Stuhlgang“ und „Häufigkeit des Stuhlgangs“.

Schlussfolgerung

Die Injektion eines Abstandhalters ist mit einem signifikanten Vorteil für Patienten nach RT des Prostatakarzinoms assoziiert.

Schlüsselwörter

Prostatakarzinom Intensitätsmodulierte Radiotherapie Bildgesteuerte Radiotherapie Lebensqualität Fragebogen Abstandhalter 
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Notes

Compliance with ethical guidelines

Conflict of interest

M. Pinkawa, V. Berneking, L. König, D. Frank, M. Bretgeld and M.J. Eble state that they have no competing interests. The Department of Radiation Oncology in Aachen participated in the initial multi-institutional clinical trial, supported by Augmenix Inc., Waltham, MA, USA. Part of the spacer material has been sponsored by Augmenix Inc.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Radiation OncologyRWTH Aachen UniversityAachenDeutschland

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