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. 2021 Apr 1;94(1120):20200931.
doi: 10.1259/bjr.20200931. Epub 2021 Jan 22.

Sexual organ-sparing with hydrogel spacer injections for rectal cancer radiotherapy: a feasibility pilot study

Vérane Achard  1 , Frederic Ris  2   3 , Michel Rouzaud  1 , Giacomo Puppa  4 , Nicolas C Buchs  2   3 , Thomas De Perrot  5 , Thibaud Koessler  6 , Cristina Picardi  1 , Thomas Zilli  1   2
Affiliations

Sexual organ-sparing with hydrogel spacer injections for rectal cancer radiotherapy: a feasibility pilot study

Vérane Achard et al. Br J Radiol. .

Abstract

Objectives: The aim of this pilot study was to investigate in two rectal cancer patients undergoing neoadjuvant chemo-radiotherapy (nCRT) the implant feasibility and dosimetric benefit in sexual organ-sparing of an injectable, absorbable, radiopaque hydrogel spacer.

Methods: Two rectal cancer patients (one male and one female) underwent hydrogel implant between rectum and vagina/prostate before nCRT and curative surgery. A CT scan was performed before and after injection and a comparative dosimetric study was performed testing a standard (45/50 Gy) and a dose escalated (46/55.2 Gy) schedule.

Results: In both patients, the spacer implant in the recto-prostatic or recto-vaginal space was feasible and well tolerated. For the male, the dosimetric benefit with spacer was minimal for sexual organs. For the female however, doses delivered to the vagina were significantly reduced with spacer with a mean reduction of more than 5 Gy for both regimens.

Conclusions: For organ preservation protocols and selected sexually active female patients, use of hydrogel spacers can be considered to spare sexual organs from the high radiotherapy dose levels.

Advances in knowledge: For females with advanced rectal tumor, a spacer implant between the rectum and the vagina before nCRT is feasible and reduces doses delivered to the vagina.

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Conflict of interest statement

Conflict of interest: TZ reports research grant from Augmenix Inc (Bedford, MA, US) for the study and Varian Medical Systems (Palo Alto, CA, US) outside the submitted work. Other authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
Axial and sagittal pelvic computed tomography views of patient #1 before (a, b) and after (c, d) the hydrogel spacer implant (GTV = gross tumor volume).
Figure 2.
Figure 2.
Axial and sagittal pelvic computed tomography views of patient #2 before (a, b) and after (c, d) the hydrogel spacer implant (GTV = gross tumor volume).
Figure 3.
Figure 3.
Cumulative dose-volume histograms for the vagina (a) and the bladder neck (b) before (triangle) and after (square) hydrogel spacer injection in the dose escalated setting for patient #1 and patient #2, respectively.
See this image and copyright information in PMC

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