TY - JOUR
T1 - Expanding the Utilization of Rectal Spacer Hydrogel for Larger Prostate Glands (>80 cc)
T2 - Feasibility and Dosimetric Outcomes
AU - Fagundes, Marcio
AU - Rodrigues, Maria Amelia
AU - Olszewski, Steve
AU - Khan, Fazal
AU - McKenzie, Craig
AU - Gutierrez, Alonso
AU - Chuong, Michael
AU - Mehta, Minesh
N1 - Funding Information:
Sources of support: This work had no specific funding. Disclosures: Dr Fagundes has a consulting agreement with Augmenix and Boston Scientific. Dr Mehta reports personal fees from Karyopharm, Tocagen, AstraZeneca Blue Earth Diagnostics, Celgene, and personal fees from Abbvie and other from Oncoceutics, outside the submitted work. Dr Gutierrez reports personal fees from ViewRay, outside the submitted work. Dr Chuong reports grants, personal fees, and nonfinancial support from ViewRay, personal fees and nonfinancial support from Sirtex, personal fees and nonfinancial support from Accuray, and grants from AstraZeneca, outside the submitted work.
Publisher Copyright:
© 2021 The Author(s)
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Purpose: The Hydrogel Spacer Prospective Randomized Pivotal Trial achieved mean rectoprostatic spacing of 12.6 mm resulting in lowering of rectal V70 from 12.4% (without spacer) to 3.3% (with spacer) in patients with glands up to 80 cm3. The value of this approach in patients with larger glands is inadequately established. This study assesses the feasibility and dosimetric outcomes of perirectal spacing in patients with prostate cancer with larger glands (>80 cm3). Methods and Materials: Between January 2017 and December 2019, 33 patients with prostate glands >80 cm3 (mean 108.1 cm3; range, 81.1-186.6 cm3) were treated, 15 with glands >80 to 100 cm3 and 18 >100 cm3. Median follow-up was 10 months (range, 3-26). The median international prostate symptom score was 9 (range, 1-18). Hydrogel was placed under local anesthesia in all cases. Treatment modality included intensity modulated radiation therapy in 15 and proton therapy (PT) in 18 patients. Treatment targeted the prostate plus seminal vesicles in 21 patients and 12 also had elective nodal irradiation. Conventional fractionation (CF) to 78 Gy in 39 fractions was used in 16 and moderate hypofractionation (HF) to 70 Gy in 28 fractions in 17 patients. Results: In the CF group, mean rectum (r) V75, 70, 60, 50 was 0.87%, 2.25%, 5.61%, and 10.5%, respectively. For glands >80 to 100 cm3 and >100 cm3, rV70 was 2.55% and 2%, respectively. In HF patients, mean rV65, 63, 60, and 50 was 1.67%, 2.3%, 3.4%, and 8.6%. For glands >80 to 100 cm3 and >100 cm3, rV63 was 2% and 2.56%, respectively. Overall, the mean midgland rectoprostatic hydrogel separation was 9.3 mm (range, 4.7-19.4 mm). All patients tolerated treatment well; no acute grade 2 or higher adverse gastrointestinal events were observed. Conclusions: Hydrogel placement is feasible in prostate glands larger than 80 cm3 with favorable dosimetric outcomes.
AB - Purpose: The Hydrogel Spacer Prospective Randomized Pivotal Trial achieved mean rectoprostatic spacing of 12.6 mm resulting in lowering of rectal V70 from 12.4% (without spacer) to 3.3% (with spacer) in patients with glands up to 80 cm3. The value of this approach in patients with larger glands is inadequately established. This study assesses the feasibility and dosimetric outcomes of perirectal spacing in patients with prostate cancer with larger glands (>80 cm3). Methods and Materials: Between January 2017 and December 2019, 33 patients with prostate glands >80 cm3 (mean 108.1 cm3; range, 81.1-186.6 cm3) were treated, 15 with glands >80 to 100 cm3 and 18 >100 cm3. Median follow-up was 10 months (range, 3-26). The median international prostate symptom score was 9 (range, 1-18). Hydrogel was placed under local anesthesia in all cases. Treatment modality included intensity modulated radiation therapy in 15 and proton therapy (PT) in 18 patients. Treatment targeted the prostate plus seminal vesicles in 21 patients and 12 also had elective nodal irradiation. Conventional fractionation (CF) to 78 Gy in 39 fractions was used in 16 and moderate hypofractionation (HF) to 70 Gy in 28 fractions in 17 patients. Results: In the CF group, mean rectum (r) V75, 70, 60, 50 was 0.87%, 2.25%, 5.61%, and 10.5%, respectively. For glands >80 to 100 cm3 and >100 cm3, rV70 was 2.55% and 2%, respectively. In HF patients, mean rV65, 63, 60, and 50 was 1.67%, 2.3%, 3.4%, and 8.6%. For glands >80 to 100 cm3 and >100 cm3, rV63 was 2% and 2.56%, respectively. Overall, the mean midgland rectoprostatic hydrogel separation was 9.3 mm (range, 4.7-19.4 mm). All patients tolerated treatment well; no acute grade 2 or higher adverse gastrointestinal events were observed. Conclusions: Hydrogel placement is feasible in prostate glands larger than 80 cm3 with favorable dosimetric outcomes.
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U2 - 10.1016/j.adro.2021.100651
DO - 10.1016/j.adro.2021.100651
M3 - Article
AN - SCOPUS:85102272974
SN - 2452-1094
VL - 6
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 3
M1 - 100651
ER -