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Application of a hydrogel spacer for postoperative salvage radiotherapy of prostate cancer

Einsatz eines Hydrogel-Abstandhalters bei der postoperativen Salvage-Radiotherapie des Prostatakarzinoms

  • Case Report
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background

In contrast to primary radiotherapy, no reports are available for a hydrogel spacer application in postoperative salvage radiotherapy for prostate cancer.

Case report

A 77-year-old patient presented 20 years after radical prostatectomy with a digitally palpable local recurrence at the urethrovesical anastomosis (PSA 5.5 ng/ml). The hydrogel spacer (10 ml, SpaceOARTM) was injected between the local recurrence and rectal wall under transrectal ultrasound guidance. Treatment planning was performed with an intensity-modulated technique up to a total dose of 76 Gy in 2-Gy fractions. The same planning was performed based on computed tomography before spacer injection for comparison.

Results

The local recurrence, initially directly on the rectal wall, could be displaced more than  1 cm from the rectal wall after hydrogel injection. With a mean total dose of 76 Gy to the planning target volume, rectal wall volumes included in the 70 Gy, 60 Gy, 50 Gy isodoses were 0 cm3, 0 cm3, and 0.4 cm3 with a spacer and 2.9 cm3, 4.5 cm3, and 6.2 cm3 without a spacer, respectively. The patient reported rectal urgency during radiotherapy, completely resolving after the end of treatment. The PSA level was 5.4 ng/ml a week before the end of radiotherapy and dropped to 0.9 ng/ml 5 months after radiotherapy.

Conclusion

A hydrogel spacer was successfully applied for dose-escalated radiotherapy in a patient with macroscopic local prostate cancer recurrence at the urethrovesical anastomosis to decrease the dose at the rectal wall. This option can be considered in specifically selected patients.

Zusammenfassung

Hintergrund

Im Gegensatz zum Einsatz bei der primären Radiotherapie gibt es bisher keine Berichte zum Einsatz eines Hydrogel-Abstandhalters bei der postoperativen Salvage-Radiotherapie des Prostatakarzinoms.

Fallbericht

Ein 77-jähriger Patient stellte sich 20 Jahre nach radikaler Prostatektomie mit einem digital palpablem Lokalrezidiv im Bereich der urethrovesikalen Anastomose vor (PSA 5,5 ng/ml). Es erfolgte eine durch einen transrektalen Ultraschall gesteuerte Injektion eines Hydrogel-Abstandhalters (10 ml, SpaceOARTM) zwischen Lokalrezidiv und Rektumwand. Die Bestrahlungsplanung erfolgte in intensitätsmodulierter Technik mit einer Verschreibungsdosis von 76 Gy und Einzeldosen von 2 Gy. Zum Vergleich wurde die gleiche Planung basierend auf einer Computertomographie vor Injektion des Abstandhalters durchgeführt.

Ergebnisse

Das ursprünglich unmittelbar an der Rektumwand gelegene Lokalrezidiv konnte nach der Hydrogelinjektion um > 1 cm von der Rektumwand distanziert werden. Bei einer mittleren Dosis von 76 Gy im Planungszielvolumen wurde innerhalb der 70-Gy-, 60-Gy-, 50-Gy-Isodose ein Rektumwandvolumen von 0 cm3, 0 cm3 und 0,4 cm3 mit Abstandhalter und 2,9 cm3, 4,5 cm3 und 6,2 cm3 bei der entsprechenden Planung ohne Abstandhalter eingeschlossen. Der Patient berichtete über vermehrten Stuhldrang während der Radiotherapie, der nach Ende der Behandlung vollständig rückläufig war. Der PSA lag bei 5,4 ng/ml eine Woche vor Ende der Radiotherapie und fiel 5 Monate nach Ende der Radiotherapie auf 0,9 ng/ml ab.

Schlussfolgerung

Ein Hydrogel-Abstandhalter wurde zur Dosiseskalation bei einem makroskopischen Lokalrezidiv eines Prostatakarzinoms im Bereich der urethrovesikalen Anastomose erfolgreich zur Entlastung der Dosis an der Rektumwand eingesetzt. Diese Option kann in Einzelfällen in Betracht gezogen werden.

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Conflict of interest

M. Pinkawa, C. Schubert, N. Escobar-Corral, R. Holy, and M.J. Eble state that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, RWTH Aachen University, Pauwelsstrasse 30, 52057, Aachen, Germany

    Michael Pinkawa, Carolin Schubert, Nuria Escobar-Corral, Richard Holy & Michael J. Eble

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  1. Michael Pinkawa
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  2. Carolin Schubert
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  3. Nuria Escobar-Corral
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  4. Richard Holy
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  5. Michael J. Eble
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Correspondence to Michael Pinkawa.

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Pinkawa, M., Schubert, C., Escobar-Corral, N. et al. Application of a hydrogel spacer for postoperative salvage radiotherapy of prostate cancer. Strahlenther Onkol 191, 375–379 (2015). https://doi.org/10.1007/s00066-014-0769-z

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  • DOI: https://doi.org/10.1007/s00066-014-0769-z

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