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Erschienen in: Strahlentherapie und Onkologie 1/2017

08.09.2016 | Original Article

Hydrogel injection reduces rectal toxicity after radiotherapy for localized prostate cancer

verfasst von: Prof. Dr. med. Michael Pinkawa, Dr. med. Vanessa Berneking, Dr. med. Liane König, Dr. med. Dilini Frank, Dr. med. Marilou Bretgeld, Prof. Dr. med. Michael J. Eble

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 1/2017

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Abstract

Purpose

Injection of a hydrogel spacer before prostate cancer radiotherapy (RT) is known to reduce the dose to the rectal wall. Clinical results from the patient’s perspective are needed to better assess a possible benefit.

Methods

A group of 167 consecutive patients who received prostate RT during the years 2010 to 2013 with 2‑Gy fractions up to 76 Gy (without hydrogel, n = 66) or 76–80 Gy (with hydrogel, n = 101) were included. The numbers of interventions resulting from bowel problems during the first 2 years after RT were compared. Patients were surveyed prospectively before RT, at the last day of RT, and at a median of 2 and 17 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite).

Results

Baseline patient characteristics were well balanced. Treatment for bowel symptoms (0 vs. 11 %; p < 0.01) and endoscopic examinations (3 vs. 19 %; p < 0.01) were performed less frequently with a spacer. Mean bowel function scores did not change for patients with a spacer in contrast to patients without a spacer (mean decrease of 5 points) >1 year after RT in comparison to baseline, with 0 vs. 12 % reporting a new moderate/big problem with passing stools (p < 0.01). Statistically significant differences were found for the items “loose stools”, “bloody stools”, “painful bowel movements” and “frequency of bowel movements”.

Conclusion

Spacer injection is associated with a significant benefit for patients after prostate cancer RT.
Literatur
1.
Zurück zum Zitat Panje CM, Dal PA, Zilli T, Zwahlen R, Papachristofilou A, Herrera FG, Matzinger O, Plasswilm L, Putora PM (2015) Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland: A survey on patterns of practice. Strahlenther Onkol 191:778–786CrossRefPubMed Panje CM, Dal PA, Zilli T, Zwahlen R, Papachristofilou A, Herrera FG, Matzinger O, Plasswilm L, Putora PM (2015) Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland: A survey on patterns of practice. Strahlenther Onkol 191:778–786CrossRefPubMed
2.
Zurück zum Zitat Drozdz S, Schwedas M, Salz H, Foller S, Wendt TG (2016) Prostate cancer treated with image-guided helical TomoTherapy(R) and image-guided LINAC-IMRT : Correlation between high-dose bladder volume, margin reduction, and genitourinary toxicity. Strahlenther Onkol 192:223–231CrossRefPubMed Drozdz S, Schwedas M, Salz H, Foller S, Wendt TG (2016) Prostate cancer treated with image-guided helical TomoTherapy(R) and image-guided LINAC-IMRT : Correlation between high-dose bladder volume, margin reduction, and genitourinary toxicity. Strahlenther Onkol 192:223–231CrossRefPubMed
3.
Zurück zum Zitat Jereczek-Fossa BA, Pobbiati C, Santoro L, Fodor C, Fanti P, Vigorito S, Baroni G, Zerini D, De CO, Orecchia R (2014) Prostate positioning using cone-beam computer tomography based on manual soft-tissue registration: interobserver agreement between radiation oncologists and therapists. Strahlenther Onkol 190:81–87CrossRefPubMed Jereczek-Fossa BA, Pobbiati C, Santoro L, Fodor C, Fanti P, Vigorito S, Baroni G, Zerini D, De CO, Orecchia R (2014) Prostate positioning using cone-beam computer tomography based on manual soft-tissue registration: interobserver agreement between radiation oncologists and therapists. Strahlenther Onkol 190:81–87CrossRefPubMed
4.
Zurück zum Zitat Pinkawa M, Piroth MD, Holy R, Djukic V, Klotz J, Krenkel B, Eble MJ (2011) Combination of dose escalation with technological advances (intensity-modulated and image-guided radiotherapy) is not associated with increased morbidity for patients with prostate cancer. Strahlenther Onkol 187:479–484CrossRefPubMed Pinkawa M, Piroth MD, Holy R, Djukic V, Klotz J, Krenkel B, Eble MJ (2011) Combination of dose escalation with technological advances (intensity-modulated and image-guided radiotherapy) is not associated with increased morbidity for patients with prostate cancer. Strahlenther Onkol 187:479–484CrossRefPubMed
5.
Zurück zum Zitat Viani GA, Stefano EJ, Alfonso SL (2009) Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys 74:1405–1418CrossRefPubMed Viani GA, Stefano EJ, Alfonso SL (2009) Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys 74:1405–1418CrossRefPubMed
6.
Zurück zum Zitat Koontz BF, Bossi A, Cozzarini C, Wiegel T, D’Amico A (2015) A systematic review of hypofractionation for primary management of prostate cancer. Eur Urol 2015(68):683–691CrossRef Koontz BF, Bossi A, Cozzarini C, Wiegel T, D’Amico A (2015) A systematic review of hypofractionation for primary management of prostate cancer. Eur Urol 2015(68):683–691CrossRef
7.
Zurück zum Zitat Brenner DJ (2004) Fractionation and late rectal toxicity. Int J Radiat Oncol Biol Phys 60:1013–1015CrossRefPubMed Brenner DJ (2004) Fractionation and late rectal toxicity. Int J Radiat Oncol Biol Phys 60:1013–1015CrossRefPubMed
9.
Zurück zum Zitat Müller A, Mischinger J, Klotz T, Gagel B, Habl G, Hatiboglu G, Pinkawa M (2016) Interdisciplinary consensus statement on indication and application of a hydrogel spacer for prostate cancer radiotherapy based on experience in more than 250 patients. Radiol Oncol (in press) Müller A, Mischinger J, Klotz T, Gagel B, Habl G, Hatiboglu G, Pinkawa M (2016) Interdisciplinary consensus statement on indication and application of a hydrogel spacer for prostate cancer radiotherapy based on experience in more than 250 patients. Radiol Oncol (in press)
10.
Zurück zum Zitat Song DY, Herfarth KK, Uhl M, Eble MJ, Pinkawa M, van TB, Kalisvaart R, Weber DC, Miralbell R, DeWeese TL, Ford EC (2013) A multi-institutional clinical trial of rectal dose reduction via injected polyethylene-glycol hydrogel during intensity modulated radiation therapy for prostate cancer: analysis of dosimetric outcomes. Int J Radiat Oncol Biol Phys 87:81–87CrossRefPubMedPubMedCentral Song DY, Herfarth KK, Uhl M, Eble MJ, Pinkawa M, van TB, Kalisvaart R, Weber DC, Miralbell R, DeWeese TL, Ford EC (2013) A multi-institutional clinical trial of rectal dose reduction via injected polyethylene-glycol hydrogel during intensity modulated radiation therapy for prostate cancer: analysis of dosimetric outcomes. Int J Radiat Oncol Biol Phys 87:81–87CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Prada PJ, Gonzalez H, Menendez C, Llaneza A, Fernandez J, Santamarta E, Ricarte PP (2009) Transperineal injection of hyaluronic acid in the anterior perirectal fat to decrease rectal toxicity from radiation delivered with low-dose-rate brachytherapy for prostate cancer patients. Brachytherapy 8:210–217CrossRefPubMed Prada PJ, Gonzalez H, Menendez C, Llaneza A, Fernandez J, Santamarta E, Ricarte PP (2009) Transperineal injection of hyaluronic acid in the anterior perirectal fat to decrease rectal toxicity from radiation delivered with low-dose-rate brachytherapy for prostate cancer patients. Brachytherapy 8:210–217CrossRefPubMed
12.
Zurück zum Zitat Pinkawa M, Corral NE, Caffaro M, Piroth MD, Holy R, Djukic V, Otto G, Schoth F, Eble MJ (2011) Application of a spacer gel to optimize three-dimensional conformal and intensity modulated radiotherapy for prostate cancer. Radiother Oncol 100:436–441CrossRefPubMed Pinkawa M, Corral NE, Caffaro M, Piroth MD, Holy R, Djukic V, Otto G, Schoth F, Eble MJ (2011) Application of a spacer gel to optimize three-dimensional conformal and intensity modulated radiotherapy for prostate cancer. Radiother Oncol 100:436–441CrossRefPubMed
13.
Zurück zum Zitat Melchert C, Gez E, Bohlen G, Scarzello G, Koziol I, Anscher M, Cytron S, Paz A, Torre T, Bassignani M, Dal MF, Jocham D, Yosef RB, Corn BW, Kovacs G (2013) Interstitial biodegradable balloon for reduced rectal dose during prostate radiotherapy: results of a virtual planning investigation based on the pre- and post-implant imaging data of an international multicenter study. Radiother Oncol 106:210–214CrossRefPubMed Melchert C, Gez E, Bohlen G, Scarzello G, Koziol I, Anscher M, Cytron S, Paz A, Torre T, Bassignani M, Dal MF, Jocham D, Yosef RB, Corn BW, Kovacs G (2013) Interstitial biodegradable balloon for reduced rectal dose during prostate radiotherapy: results of a virtual planning investigation based on the pre- and post-implant imaging data of an international multicenter study. Radiother Oncol 106:210–214CrossRefPubMed
14.
Zurück zum Zitat Strom TJ, Wilder RB, Fernandez DC, Mellon EA, Saini AS, Hunt DC, Pow-Sang JM, Spiess PE, Sexton WJ, Poch MA, Biagioli MC (2014) A dosimetric study of polyethylene glycol hydrogel in 200 prostate cancer patients treated with high-dose rate brachytherapy+/-intensity modulated radiation therapy. Radiother Oncol 111:126–131CrossRefPubMed Strom TJ, Wilder RB, Fernandez DC, Mellon EA, Saini AS, Hunt DC, Pow-Sang JM, Spiess PE, Sexton WJ, Poch MA, Biagioli MC (2014) A dosimetric study of polyethylene glycol hydrogel in 200 prostate cancer patients treated with high-dose rate brachytherapy+/-intensity modulated radiation therapy. Radiother Oncol 111:126–131CrossRefPubMed
15.
Zurück zum Zitat Mariados N, Sylvester J, Shah D, Karsh L, Hudes R, Beyer D, Kurtzman S, Bogart J, Hsi RA, Kos M, Ellis R, Logsdon M, Zimberg S, Forsythe K, Zhang H, Soffen E, Francke P, Mantz C, Rossi P, DeWeese T, Hamstra DA, Bosch W, Gay H, Michalski J (2015) Hydrogel spacer prospective multicenter randomized controlled pivotal trial: dosimetric and clinical effects of perirectal spacer application in men undergoing prostate image guided intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 92:971–977CrossRefPubMed Mariados N, Sylvester J, Shah D, Karsh L, Hudes R, Beyer D, Kurtzman S, Bogart J, Hsi RA, Kos M, Ellis R, Logsdon M, Zimberg S, Forsythe K, Zhang H, Soffen E, Francke P, Mantz C, Rossi P, DeWeese T, Hamstra DA, Bosch W, Gay H, Michalski J (2015) Hydrogel spacer prospective multicenter randomized controlled pivotal trial: dosimetric and clinical effects of perirectal spacer application in men undergoing prostate image guided intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 92:971–977CrossRefPubMed
16.
Zurück zum Zitat Abdollah F, Cozzarini C, Suardi N, Gallina A, Capitanio U, Bianchi M, Tutolo M, Salonia A, La MM, Di MN, Rigatti P, Montorsi F, Briganti A (2012) Indications for pelvic nodal treatment in prostate cancer should change. Validation of the Roach formula in a large extended nodal dissection series. Int J Radiat Oncol Biol Phys 83:624–629CrossRefPubMed Abdollah F, Cozzarini C, Suardi N, Gallina A, Capitanio U, Bianchi M, Tutolo M, Salonia A, La MM, Di MN, Rigatti P, Montorsi F, Briganti A (2012) Indications for pelvic nodal treatment in prostate cancer should change. Validation of the Roach formula in a large extended nodal dissection series. Int J Radiat Oncol Biol Phys 83:624–629CrossRefPubMed
17.
Zurück zum Zitat Müller A, Mischinger J, Klotz T, Gagel B, Habl G, Hatiboglu G, Pinkawa M (2016) Interdisciplinary consensus statement on indication and application of a hydrogel spacer for prostate radiotherapy based on experience in more than 250 patients. Radiol Oncol 50:329–336CrossRefPubMedPubMedCentral Müller A, Mischinger J, Klotz T, Gagel B, Habl G, Hatiboglu G, Pinkawa M (2016) Interdisciplinary consensus statement on indication and application of a hydrogel spacer for prostate radiotherapy based on experience in more than 250 patients. Radiol Oncol 50:329–336CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Hatiboglu G, Pinkawa M, Vallee JP, Hadaschik B, Hohenfellner M (2012) Application technique: placement of a prostate-rectum spacer in men undergoing prostate radiation therapy. BJU Int 110:E647–E652CrossRefPubMed Hatiboglu G, Pinkawa M, Vallee JP, Hadaschik B, Hohenfellner M (2012) Application technique: placement of a prostate-rectum spacer in men undergoing prostate radiation therapy. BJU Int 110:E647–E652CrossRefPubMed
19.
Zurück zum Zitat Volz-Sidiropoulou E, Pinkawa M, Fischedick K, Jakse G, Gauggel S, Eble MJ (2008) Factor analysis of the Expanded Prostate Cancer Index Composite (EPIC) in a patient group after primary (external beam radiotherapy and permanent iodine-125 brachytherapy) and postoperative radiotherapy for prostate cancer. Curr Urol 2:122–129CrossRef Volz-Sidiropoulou E, Pinkawa M, Fischedick K, Jakse G, Gauggel S, Eble MJ (2008) Factor analysis of the Expanded Prostate Cancer Index Composite (EPIC) in a patient group after primary (external beam radiotherapy and permanent iodine-125 brachytherapy) and postoperative radiotherapy for prostate cancer. Curr Urol 2:122–129CrossRef
20.
Zurück zum Zitat Pinkawa M, Holy R, Piroth DM, Klotz J, Pfister D, Heidenreich A, Eble MJ (2011) Interpreting the clinical significance of quality of life score changes after radiotherapy for localized prostate cancer. Curr Urol 5:137–144CrossRef Pinkawa M, Holy R, Piroth DM, Klotz J, Pfister D, Heidenreich A, Eble MJ (2011) Interpreting the clinical significance of quality of life score changes after radiotherapy for localized prostate cancer. Curr Urol 5:137–144CrossRef
21.
Zurück zum Zitat Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16:139–144PubMed Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16:139–144PubMed
22.
Zurück zum Zitat Wilder RB, Barme GA, Gilbert RF, Holevas RE, Kobashi LI, Reed RR, Solomon RS, Walter NL, Chittenden L, Mesa AV, Agustin J, Lizarde J, Macedo J, Ravera J, Tokita KM (2010) Cross-linked hyaluronan gel reduces the acute rectal toxicity of radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 77:824–830CrossRefPubMed Wilder RB, Barme GA, Gilbert RF, Holevas RE, Kobashi LI, Reed RR, Solomon RS, Walter NL, Chittenden L, Mesa AV, Agustin J, Lizarde J, Macedo J, Ravera J, Tokita KM (2010) Cross-linked hyaluronan gel reduces the acute rectal toxicity of radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 77:824–830CrossRefPubMed
23.
Zurück zum Zitat Picardi C, Rouzaud M, Kountouri M, Lestrade L, Vallee JP, Caparrotti F, Dubouloz A, Miralbell R, Zilli T (2016) Impact of hydrogel spacer injections on interfraction prostate motion during prostate cancer radiotherapy. Acta Oncol 21:1–5 Picardi C, Rouzaud M, Kountouri M, Lestrade L, Vallee JP, Caparrotti F, Dubouloz A, Miralbell R, Zilli T (2016) Impact of hydrogel spacer injections on interfraction prostate motion during prostate cancer radiotherapy. Acta Oncol 21:1–5
24.
Zurück zum Zitat Pinkawa M, Piroth MD, Holy R, Escobar-Corral N, Caffaro M, Djukic V, Klotz J, Eble MJ (2013) Spacer stability and prostate position variability during radiotherapy for prostate cancer applying a hydrogel to protect the rectal wall. Radiother Oncol 106:220–224CrossRefPubMed Pinkawa M, Piroth MD, Holy R, Escobar-Corral N, Caffaro M, Djukic V, Klotz J, Eble MJ (2013) Spacer stability and prostate position variability during radiotherapy for prostate cancer applying a hydrogel to protect the rectal wall. Radiother Oncol 106:220–224CrossRefPubMed
25.
Zurück zum Zitat Uhl M, Herfarth K, Eble MJ, Pinkawa M, van Triest B, Kalisvaart R, Weber DC, Miralbell R, Song DY, DeWeese TL (2014) Absorbable hydrogel spacer use in men undergoing prostate cancer radiotherapy: 12 month toxicity and proctoscopy results of a prospective multicenter phase II trial. Radiat Oncol 9:96CrossRefPubMedPubMedCentral Uhl M, Herfarth K, Eble MJ, Pinkawa M, van Triest B, Kalisvaart R, Weber DC, Miralbell R, Song DY, DeWeese TL (2014) Absorbable hydrogel spacer use in men undergoing prostate cancer radiotherapy: 12 month toxicity and proctoscopy results of a prospective multicenter phase II trial. Radiat Oncol 9:96CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Pinkawa M, Klotz J, Djukic V, Schubert C, Escobar-Corral N, Caffaro M, Piroth MD, Holy R, Eble MJ (2013) Learning curve in the application of a hydrogel spacer to protect the rectal wall during radiotherapy of localized prostate cancer. Urology 82:963–968CrossRefPubMed Pinkawa M, Klotz J, Djukic V, Schubert C, Escobar-Corral N, Caffaro M, Piroth MD, Holy R, Eble MJ (2013) Learning curve in the application of a hydrogel spacer to protect the rectal wall during radiotherapy of localized prostate cancer. Urology 82:963–968CrossRefPubMed
27.
Zurück zum Zitat Pinkawa M, Piroth MD, Holy R, Escobar-Corral N, Caffaro M, Djukic V, Klotz J, Eble MJ (2012) Quality of life after intensity-modulated radiotherapy for prostate cancer with a hydrogel spacer. Matched-pair analysis. Strahlenther Onkol 188:917–925CrossRefPubMed Pinkawa M, Piroth MD, Holy R, Escobar-Corral N, Caffaro M, Djukic V, Klotz J, Eble MJ (2012) Quality of life after intensity-modulated radiotherapy for prostate cancer with a hydrogel spacer. Matched-pair analysis. Strahlenther Onkol 188:917–925CrossRefPubMed
28.
Zurück zum Zitat Muanza TM, Albert PS, Smith S, Godette D, Crouse NS, Cooley-Zgela T, Sciuto L, Camphausen K, Coleman CN, Menard C, Muanza TM, Albert PS, Smith S, Godette D, Crouse NS, Cooley-Zgela T, Sciuto L, Camphausen K, Coleman CN, Menard C (2005) Comparing measures of acute bowel toxicity in patients with prostate cancer treated with external beam radiation therapy. Int J Radiat Oncol Biol Phys 62:1316–1321CrossRefPubMed Muanza TM, Albert PS, Smith S, Godette D, Crouse NS, Cooley-Zgela T, Sciuto L, Camphausen K, Coleman CN, Menard C, Muanza TM, Albert PS, Smith S, Godette D, Crouse NS, Cooley-Zgela T, Sciuto L, Camphausen K, Coleman CN, Menard C (2005) Comparing measures of acute bowel toxicity in patients with prostate cancer treated with external beam radiation therapy. Int J Radiat Oncol Biol Phys 62:1316–1321CrossRefPubMed
Metadaten
Titel
Hydrogel injection reduces rectal toxicity after radiotherapy for localized prostate cancer
verfasst von
Prof. Dr. med. Michael Pinkawa
Dr. med. Vanessa Berneking
Dr. med. Liane König
Dr. med. Dilini Frank
Dr. med. Marilou Bretgeld
Prof. Dr. med. Michael J. Eble
Publikationsdatum
08.09.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Strahlentherapie und Onkologie / Ausgabe 1/2017
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-016-1040-6

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