Department of Radiation Oncology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, Tübingen 72076, Germany.
BMC Cancer. 2013 Jan 22;13:27. doi: 10.1186/1471-2407-13-27.
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.
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.
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.
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.
German Clinical Trials Register DRKS00003273.
随着前列腺癌放射治疗的剂量递增，提高了治愈率，人们主要关注的是直肠毒性。我们前瞻性评估了一种在前列腺和直肠之间注射水凝胶的创新方法，以减少直肠的放射剂量，从而降低剂量递增前列腺放射治疗的副作用。
在接受水凝胶间隔物剂量递增放射治疗的 T1-2N0M0 前列腺癌患者中，前瞻性评估急性毒性和计划参数。在注射水凝胶间隔物前后，我们对直肠分离的解剖学评估进行了 MRI 扫描。放射治疗计划为 78Gy，共 39 次分割。
从 11 名计划注射间隔物的患者中，10 名患者能够进行该操作。在一名患者中，无法进行 Denonvillier 空间的水分离。尽管对靶区进行了剂量递增，但放射治疗计划显示直肠的低剂量。与此一致，急性直肠毒性轻微，无 2 级事件，且在 4 至 12 周内完全缓解。
这项前瞻性研究表明，水凝胶注射是可行的，可以预防前列腺癌剂量递增放疗中的直肠毒性。需要进一步评估，包括定义可能受益于这种方法的患者。
德国临床试验注册处 DRKS00003273。
