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What is the quality of hydrogel spacer insertions? and which patients will benefit? A literature review

Published online by Cambridge University Press:  15 January 2020

Joseph Drabble Open the ORCID record for Joseph Drabble [Opens in a new window]  and
Heather Drury-Smith
Joseph Drabble*
Affiliation:
GenesisCare, Oxford, UK
Heather Drury-Smith
Affiliation:
Sheffield Hallam University, Sheffield, UK
*
Author for correspondence: Joseph Drabble, GenesisCare, Sandy Ln W, OxfordOX4 6LB, UK. E-mail: [email protected]
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Abstract

Aim:

To evaluate the quality of rectal hydrogel spacer (HS) insertions from literature in patients undergoing radical radiotherapy for prostate cancer. The secondary aim is to assess the benefit of HSs in patients with risk factors more likely to have rectal complications, such as non-conventional radiotherapy dose fractionations and high-risk disease.

Method and materials:

A literature search of peer-reviewed electronic articles was carried out using Boolean connectors and Medical Subject Headings in the databases. Databases searched included ScienceDirect, Medline and Cinahl. The articles were assessed using relevant critical appraisal skills programme tools.

Results:

From the 26 studies used, HS showed a clinically significant relative reduction in rectal planning dose volumes for both high- and low-risk prostate cancer patients in a range of radiotherapy treatment modalities including volumetric modulated arc therapy, intensity-modulated radiotherapy, intensity-modulated proton therapy, stereotactic ablative body radiotherapy and brachytherapy. Spacer placements were successfully inserted in 99% of patients. However, rectal wall infiltration occurrence was 6% and ≥2 cm unsymmetrical placements in 2%.

Findings:

A spacer scoring system based on the HS symmetry has provided evidence of the quality of the position inserted, which was visually aided by T2-wieghted MRIs. Despite optimal HS placements ranging from 62 to 72%, HS had a clinically significant reduction of ≥25% in planned rectal V70 dose in 97% of patients.

Keywords

gastrointestinal toxicityhydrogel spacerprostate cancerrectal wall infiltration
Type
Literature Review
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 4 , December 2020 , pp. 385 - 392
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Copyright
© The Author(s), 2020. Published by Cambridge University Press.

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