Case series illustrating the synergistic use of hydrogel spacer and MR-guidance to increase the radiotherapeutic index for localized prostate cancer.
MRI-guided brachytherapy
Polyethylene glycol hydrogel spacer
Prostate cancer
Rectal toxicity
Journal
Technical innovations & patient support in radiation oncology
ISSN: 2405-6324
Titre abrégé: Tech Innov Patient Support Radiat Oncol
Pays: England
ID NLM: 101762366
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
received:
05
02
2019
revised:
24
07
2019
accepted:
30
08
2019
entrez:
26
2
2020
pubmed:
26
2
2020
medline:
26
2
2020
Statut:
epublish
Résumé
The risk of gastrointestinal (GI) toxicity may limit the use of curative-intent radical radiotherapy (RT) for prostate cancer (PCa) in circumstances where morbidity of treatment may exceed an acceptable threshold. Rectal spacers are used to expand the distance between the anterior rectal wall and the prostate, consequently sparing the rectum from the high-dose region. We report three clinical scenarios of PCa patients treated at our institution, where risk of RT-associated rectal toxicity may be increased: inflammatory bowel disease (IBD), salvage brachytherapy (BT) after previous external beam RT (EBRT), and tailored dose-escalation with focal BT to the gross tumor volume followed by stereotactic body RT. Prior to RT, a polyethylene glycol (PEG) hydrogel spacer was successfully placed in all cases. Treatment comprised magnetic resonance (MR) guided high dose-rate BT ± EBRT. All patients completed treatment uneventfully, without any significant GI toxicity at last follow-up. These cases illustrate the utility of PEG hydrogel spacer, where concerns of radiation induced toxicity may have previously limited the application of radiotherapy. The synergistic use of these novel devices together with MR-guided BT may expand the indications and therapeutic index of curative-intent RT-based treatments, while minimizing the risks of GI toxicity.
Sections du résumé
BACKGROUND
BACKGROUND
The risk of gastrointestinal (GI) toxicity may limit the use of curative-intent radical radiotherapy (RT) for prostate cancer (PCa) in circumstances where morbidity of treatment may exceed an acceptable threshold. Rectal spacers are used to expand the distance between the anterior rectal wall and the prostate, consequently sparing the rectum from the high-dose region.
CASE PRESENTATIONS
METHODS
We report three clinical scenarios of PCa patients treated at our institution, where risk of RT-associated rectal toxicity may be increased: inflammatory bowel disease (IBD), salvage brachytherapy (BT) after previous external beam RT (EBRT), and tailored dose-escalation with focal BT to the gross tumor volume followed by stereotactic body RT. Prior to RT, a polyethylene glycol (PEG) hydrogel spacer was successfully placed in all cases. Treatment comprised magnetic resonance (MR) guided high dose-rate BT ± EBRT. All patients completed treatment uneventfully, without any significant GI toxicity at last follow-up.
CONCLUSIONS
CONCLUSIONS
These cases illustrate the utility of PEG hydrogel spacer, where concerns of radiation induced toxicity may have previously limited the application of radiotherapy. The synergistic use of these novel devices together with MR-guided BT may expand the indications and therapeutic index of curative-intent RT-based treatments, while minimizing the risks of GI toxicity.
Identifiants
pubmed: 32095546
doi: 10.1016/j.tipsro.2019.08.002
pii: S2405-6324(19)30003-4
pmc: PMC7033779
doi:
Types de publication
Case Reports
Langues
eng
Pagination
22-25Informations de copyright
© 2019 The Authors.
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