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. 2015 Dec 10;6(6):189-93.
doi: 10.5306/wjco.v6.i6.189.

Current role of spacers for prostate cancer radiotherapy

Michael Pinkawa  1
Affiliations

Current role of spacers for prostate cancer radiotherapy

Michael Pinkawa. World J Clin Oncol. .

Abstract

Radiotherapy is an established curative treatment method for prostate cancer. Optimal tumor control rates can only be achieved with high local doses, associated with a considerable risk of rectal toxicity. Apart from already widely adapted technical advances, as intensity-modulated radiation therapy, the application of spacers placed between the prostate and rectum has been increasingly used in the last years. Biodegradable spacers, including hydrogel, hyaluronic acid, collagen or an implantable balloon, can be injected or inserted in a short procedure under transrectal ultrasound guidance via a transperineal approach. A distance of about 1.0-1.5 cm is usually achieved between the rectum and prostate, excluding the rectal wall from the high isodoses. Several studies have shown well tolerated injection procedures and treatments. Apart from considerable reduction of rectal irradiation, a prospective randomized trial demonstrated a reduction of rectal toxicity after hydrogel injection in men undergoing prostate image-guided intensity-modulated radiation therapy. The results are encouraging for continuing evaluation in dose escalation, hypofractionation, stereotactic radiotherapy or re-irradiation trials in the future.

Keywords: Biodegradable balloon; Brachytherapy; Collagen; External-beam radiotherapy; Hyaluronic acid; Hydrogel; Intensity-modulated radiotherapy; Prostate cancer; Spacer; Toxicity.

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Figures

Figure 1
Figure 1
T2 weighted magnetic resonance imaging without (left) and with (right) a hydrogel spacer. Spacer hyperintense, resulting in > 1 cm separation between prostate and rectum.
See this image and copyright information in PMC

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