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Open Access Research article

Prospective evaluation of a hydrogel spacer for rectal separation in dose-escalated intensity-modulated radiotherapy for clinically localized prostate cancer

Franziska Eckert1, Saladin Alloussi2, Frank Paulsen1, Michael Bamberg1, Daniel Zips1, Patrick Spillner1, Cihan Gani1, Ulrich Kramer3, Daniela Thorwarth4, David Schilling2 and Arndt-Christian Müller1*

Author Affiliations

1 Department of Radiation Oncology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany

2 Department of Urology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany

3 Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany

4 Section for Biomedical Physics, Department of Radiation Oncology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany

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BMC Cancer 2013, 13:27  doi:10.1186/1471-2407-13-27

Published: 22 January 2013

Abstract

Background

As dose-escalation in prostate cancer radiotherapy improves cure rates, a major concern is rectal toxicity. We prospectively assessed an innovative approach of hydrogel injection between prostate and rectum to reduce the radiation dose to the rectum and thus side effects in dose-escalated prostate radiotherapy.

Methods

Acute toxicity and planning parameters were prospectively evaluated in patients with T1-2 N0 M0 prostate cancer receiving dose-escalated radiotherapy after injection of a hydrogel spacer. Before and after hydrogel injection, we performed MRI scans for anatomical assessment of rectal separation. Radiotherapy was planned and administered to 78 Gy in 39 fractions.

Results

From eleven patients scheduled for spacer injection the procedure could be performed in ten. In one patient hydrodissection of the Denonvillier space was not possible. Radiation treatment planning showed low rectal doses despite dose-escalation to the target. In accordance with this, acute rectal toxicity was mild without grade 2 events and there was complete resolution within four to twelve weeks.

Conclusions

This prospective study suggests that hydrogel injection is feasible and may prevent rectal toxicity in dose-escalated radiotherapy of prostate cancer. Further evaluation is necessary including the definition of patients who might benefit from this approach. Trial registration: German Clinical Trials Register DRKS00003273.

Keywords:
Prostate cancer; Intensity-modulated radiotherapy; Hydrogel spacer; Rectal toxicity; Dose-escalation