Format

Send to

Choose Destination
J Appl Clin Med Phys. 2019 Apr;20(4):91-98. doi: 10.1002/acm2.12566. Epub 2019 Mar 19.

Maximizing rectal dose sparing with hydrogel: A retrospective planning study.

Author information

1
Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada.
2
Department of Medical Physics, BC Cancer - Victoria, Victoria, BC, Canada.
3
Department of Radiation Oncology, BC Cancer - Victoria, Victoria, BC, Canada.
4
Department of Surgery, University of British Columbia, Vancouver, BC, Canada.

Abstract

External beam radiation therapy for prostate cancer can result in urinary, sexual, and rectal side effects, often impairing quality of life. A polyethylene glycol-based product, SpaceOAR© hydrogel (SOH), implanted into the connective tissue between the prostate gland and rectum can significantly reduce the dose received by the rectum and hence risk of rectal toxicity. The optimal way to manage the hydrogel and rectal structures for plan optimization is therefore of interest. In 13 patients, computerized tomography (CT) scans were taken pre- and post-SpaceOAR© implant. A prescription of 60 Gy in 20 fractions was planned on both scans. Six treatment plans were produced per anonymized dataset using either a structure of rectum plus the hydrogel, termed composite rectum wall (CRW), or rectal wall (RW) as an inverse optimization structure and intensity modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) as a treatment technique. Dose-volume histogram metrics were compared between plans to determine which optimization structure and treatment technique offered the maximum rectal dose sparing. RW structures offered a statistically significant decrease in rectal dose over CRW structures, whereas the treatment technique (IMRT vs VMAT) did not significantly affect the rectal dose. There was improvement seen in bladder and penile bulb dose when VMAT was used as a treatment technique. Overall, treatment plans using the RW optimization structure offered the lowest rectal dose while VMAT treatment technique offered the lowest bladder and penile bulb dose.

KEYWORDS:

EBRT ; SpaceOAR; hydrogel; prostate; rectal sparing

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center