Role of rectal spacers in gynecological cancer radiotherapy: reducing rectal dose and treatment-related toxicity.

BACKGROUND

This review examines the role of rectal spacers in gynecological cancer radiation therapy, highlighting their potential to mitigate radiation-induced toxicities, improve treatment precision, and enhance patient quality of life. The analysis explores different spacer materials, insertion techniques, and clinical applications while addressing current challenges and limitations.

MATERIALS AND METHODS

A systematic review of studies evaluating rectal spacers in external beam radiation therapy (EBRT), brachytherapy, and stereotactic body radiation therapy (SBRT) for gynecological malignancies was conducted using PubMed, Scopus, and Embase. The review includes prospective and retrospective studies, clinical trials, and case reports from 2005-2024. Keywords used were "rectal spacers", "gynecological cancer radiotherapy", and "hydrogel spacers".

RESULTS

Rectal spacers demonstrate significant dosimetric advantages in reducing rectal dose exposure in gynecological cancers, particularly in brachytherapy. However, the spacer placement area overlaps with the clinical target volume (CTV), necessitating careful consideration in treatment planning. The integration of rectal spacers in SBRT is still emerging, with limited clinical data available. Limitations include cost, risk of migration, and patient discomfort. Additionally, cost-effectiveness and routine implementation in clinical practice require further investigation.

CONCLUSIONS

While rectal spacers provide significant benefits in reducing toxicity, their role in treatment precision remains debatable. Further research is needed to refine patient selection and cost-effectiveness. Future research should focus on refining patient selection criteria, improving spacer stability, and evaluating long-term clinical and economic impacts.