Use of a rectal spacer with low-dose-rate brachytherapy for treatment of prostate cancer in previously irradiated patients: Initial experience and short-term results.

Abstract

BACKGROUND:

Salvage brachytherapy in patients with prior pelvic radiation carries a risk of rectal injury. Herein, we report our initial experience using a hydrogel spacer between the prostate and the rectum during salvage brachytherapy.

METHODS AND MATERIALS:

A total of 11 patients with prostate cancer and prior radiotherapy (5 prostate brachytherapy, 2 prostate external beam radiation therapy [EBRT], and 4 rectal cancer EBRT) received (125)I brachytherapy after attempted placement of 10cc of a diluted hydrogel spacer between the prostate and rectum.

RESULTS:

Spacing was achieved in 8 of the 11 (73%) patients but was not possible in 3 (1 prior brachytherapy and 2 prior EBRT) owing to fibrosis and adhesions. For the 8 patients in whom spacing was accomplished, the median space between the prostate and rectum was 10.9mm (prior EBRT) vs. 7.7mm (prior brachytherapy), p=0.048. Median followup was 15.7 months. One patient developed a prostato-rectal fistula requiring a diverting colostomy. The 16-month estimate of late Grade 3 or 4 gastrointestinal or genitourinary toxicity was 26%. One patient developed lymph node-positive recurrence. The 16-month prostate-specific antigen failure-free survival rate was 89%. Compared with baseline, Expanded Prostate Cancer Index Composite for Clinical Practice urinary quality of life (QoL) was significantly worse at 3 and 6 months but not significantly worse by 1 year. There were no significant changes throughout the study period in bowel or sexual QoL.

CONCLUSION:

Hydrogel spacer placements may be feasible in most patients with prior pelvic radiation. Further followup is needed to determine whether spacer placement will produce long-term improvements in toxicity or QoL.

• Authors: Brandon A Mahal, David R Ziehr, Andrew S Hyatt, Emily H Neubauer-Sugar, Desmond A O'Farrell, Michael P O'Leary, Graeme S Steele, Thomas R Niedermayr, Clair J Beard, Neil E Martin, Peter F Orio, Anthony V D'Amico, Phillip M Devlin, Paul L Nguyen
• Journal: Brachytherapy (Brachytherapy) 2014 Sep-Oct Vol. 13 Issue 5 Pg. 442-9 ISSN: 1873-1449 [Electronic] United States
• PMID: 24880584 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Hydrogel, Polyethylene Glycol Dimethacrylate

Topics

• Aged
• Aged, 80 and over
• Brachytherapy (adverse effects, methods)
• Feasibility Studies
• Follow-Up Studies
• Humans
• Hydrogel, Polyethylene Glycol Dimethacrylate
• Male
• Middle Aged
• Neoplasm Recurrence, Local (mortality, radiotherapy)
• Organs at Risk (radiation effects)
• Prostatic Neoplasms (mortality, radiotherapy)
• Quality of Life
• Radiotherapy Dosage
• Rectum (radiation effects)
• Salvage Therapy (adverse effects, methods)
• Survival Analysis
• Treatment Outcome