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Distribution analysis of hydrogel spacer and evaluation of rectal dose reduction in Japanese prostate cancer patients undergoing stereotactic body radiation therapy

International Journal of Clinical Oncology volume 26, pages 736–743 (2021)Cite this article

Abstract

Background

To report on our primary experience with the placement of a hydrogel spacer following stereotactic body radiation therapy (SBRT) in low- and intermediate-risk prostate cancer patients and assess its impact on dosimetry as well as acute toxicity.

Methods

A total of 70 patients treated with SBRT (total dose of 36.25 Gy) in 5 fractions were included. Hydrogel spacers were inserted in 53 patients along with gold fiducial markers. For dosimetry, we trisected the rectum on the sagittal image of magnetic resonance imaging and defined it as the upper rectum (UR), middle rectum (MR), and lower rectum (LR). We compared the dose to each part of the rectum with and without hydrogel spacer using dose volume histograms. Genitourinary (GU) and gastrointestinal (GI) toxicity assessments were conducted until 6 months of follow-up visits.

Results

The median volume of the hydrogel spacer was 12.3 mL. Overall, the hydrogel spacer could significantly reduce the rectal dose in the middle-to-high-dose region (V20–V35). The rectum doses at the UR and MR were significantly lower in the spacer group in the middle to high dose region (V20–V35); the dose at the LR was significantly lower in the spacer group in the high-dose region (V30–V35). There was no grade ≥ 3 toxicity observed, but grade 2 toxicity of GU and GI occurred in 17.1% and 1.4% of the patients, respectively.

Conclusion

Hydrogel spacers could contribute to rectal dose reduction, especially in high dose regions, by creating a prostate–rectum distance.

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References

  1. Hamdy FC, Donovan JL, Lane JA et al (2016) 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 375:1415–1424

    Article  Google Scholar 

  2. Widmark A, Klepp O, Solberg A et al (2009) Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet 373:301–308

    Article  CAS  Google Scholar 

  3. Warde P, Mason M, Ding K et al (2011) Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. Lancet 378:2104–2111

    Article  CAS  Google Scholar 

  4. Potters L, Kavanagh B, Galvin JM et al (2010) American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the performance of stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 76:326–332

    Article  Google Scholar 

  5. Avkshtol V, Dong Y, Hayes SB et al (2016) A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer. Res Rep Urol 8:145–158

    PubMed  PubMed Central  CAS  Google Scholar 

  6. Oliai C, Bernetich M, Brady L et al (2016) Propensity score matched comparison of SBRT versus IMRT for the treatment of localized prostate cancer. J Radiat Oncol 5:187–195

    Article  Google Scholar 

  7. Kishan AU, Wang PC, Upadhyaya SK et al (2016) SBRT and HDR brachytherapy produce lower PSA nadirs and different PSA decay patterns than conventionally fractionated IMRT in patients with low- or intermediate-risk prostate cancer. PractRadiat Oncol 6:268–275

    Google Scholar 

  8. Mariados N, Sylvester J, Shah D et al (2015) Hydrogel spacer prospective multicenter randomized controlled pivotal trial: dosimetric and clinical effects of perirectal spacer application in men undergoing prostate image guided intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 92:971–977

    Article  Google Scholar 

  9. Taggar AS, Charas T, Cohen GN et al (2018) Placement of an absorbable rectal hydrogel spacer in patients undergoing low-dose-rate brachytherapy with palladium-103. Brachytherapy 17:251–258

    Article  Google Scholar 

  10. Morita M, Fukagai T, Hirayama K et al (2020) Placement of Space OAR hydrogel spacer for prostate cancer patients treated with iodine-125 low-dose-rate brachytherapy. Int J Urol 27:60–66

    Article  CAS  Google Scholar 

  11. Hwang ME, Mayeda M, Liz M et al (2019) Stereotactic body radiotherapy with periprostatic hydrogel spacer for localized prostate cancer: toxicity profile and early oncologic outcomes. Radiat Oncol 14:136. https://doi.org/10.1186/s13014-019-1346-5

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Mohler JL, Antonarakis ES, Armstrong AJ et al (2019) Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl ComprCancNetw 17:479–505

    CAS  Google Scholar 

  13. Fischer-Valuck BW, Chundury A, Gay H et al (2017) Hydrogel spacer distribution within the perirectal space in patients undergoing radiotherapy for prostate cancer: impact of spacer symmetry on rectal dose reduction and the clinical consequences of hydrogel infiltration into the rectal wall. PractRadiat Oncol 7:195–202

    Google Scholar 

  14. Lee SE, Byun SS, Lee HJ et al (2006) Impact of variations in prostatic apex shape on early recovery of urinary continence after radical retropubic prostatectomy. Urology 68:137–141

    Article  Google Scholar 

  15. Brand DH, Tree AC, Ostler P et al (2019) Intensity-modulated fractionated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): acute toxicity findings from an international, randomised, open-label, phase 3, non-inferiority trial. Lancet Oncol 20:1531–1543

    Article  Google Scholar 

  16. Widmark A, Gunnlaugsson A, Beckman L et al (2019) Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial. Lancet 394:385–395

    Article  Google Scholar 

  17. Kishan AU, Dang A, Katz AJ et al (2019) Long-term outcomes of stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer. JAMANetw Open 2:e188006

    Google Scholar 

  18. Hamstra DA, Mariados N, Sylvester J et al (2017) Continued benefit to rectal separation for prostate radiation therapy: final results of a phase iii trial. Int J Radiat Oncol Biol Phys 97:976–985

    Article  Google Scholar 

  19. Wang K, Chen RC, Kane BL et al (2018) Patient and dosimetric predictors of genitourinary and bowel quality of life after prostate SBRT: secondary analysis of a multi-institutional trial. Int J Radiat Oncol Biol Phys 102:1430–1437

    Article  Google Scholar 

  20. Pederson AW, Fricano J, Correa D et al (2012) Late toxicity after intensity-modulated radiation therapy for localized prostate cancer: an exploration of dose-volume histogram parameters to limit genitourinary and gastrointestinal toxicity. Int J Radiat Oncol Biol Phys 82:235–241

    Article  Google Scholar 

  21. Thor M, Deasy JO, Paulus R et al (2019) Tolerance doses for late adverse events after hypofractionated radiotherapy for prostate cancer on trial NRG Oncology/RTOG 0415. Radiother Oncol 135:19–24

    Article  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Affiliations

  1. Department of Urology, Saiseikai Yokohamashi Tobu hospital, 3-6-1, Shimosueyoshi, Tsurumi-ku, Yokohama city, Kanagawa, 230-8765, Japan

    Hiroaki Kobayashi, Masaru Ishida, Yosuke Nakajima & Michio Kosugi

  2. Department of Radiation Oncology, Saiseikai Yokohamashi Tobu hospital, Yokohama city, Japan

    Takahisa Eriguchi, Tomoki Tanaka, Takeru Ogata & Atsuhiro Kumabe

Authors
  1. Hiroaki Kobayashi
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  2. Takahisa Eriguchi
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  3. Tomoki Tanaka
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  4. Takeru Ogata
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  5. Masaru Ishida
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  6. Yosuke Nakajima
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  7. Atsuhiro Kumabe
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  8. Michio Kosugi
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Correspondence to Hiroaki Kobayashi.

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Kobayashi, H., Eriguchi, T., Tanaka, T. et al. Distribution analysis of hydrogel spacer and evaluation of rectal dose reduction in Japanese prostate cancer patients undergoing stereotactic body radiation therapy. Int J Clin Oncol 26, 736–743 (2021). https://doi.org/10.1007/s10147-020-01855-y

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  • DOI: https://doi.org/10.1007/s10147-020-01855-y

Keywords

  • Stereotactic body radiation therapy
  • Hydrogel spacer
  • Rectal dose reduction
  • Genitourinary and gastrointestinal toxicities