Fatima Hadia, Fatima Rumsha
Radiation Oncology Department, King Abdulaziz Medical City, Ministry of National Guards, Health Affairs, Riyadh, Saudi Arabia.
National University of Sciences and Technology, Islamabad, Pakistan.
Rep Pract Oncol Radiother. 2025 Jun 7;30(2):246-256. doi: 10.5603/rpor.105854. eCollection 2025.
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.
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".
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.
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.
本综述探讨直肠间隔器在妇科癌症放射治疗中的作用，强调其减轻放射诱导毒性、提高治疗精度和改善患者生活质量的潜力。分析探讨了不同的间隔器材料、置入技术和临床应用，同时讨论了当前面临的挑战和局限性。
使用PubMed、Scopus和Embase对评估直肠间隔器在妇科恶性肿瘤外照射放疗（EBRT）、近距离放疗和立体定向体部放疗（SBRT）中的研究进行系统综述。该综述纳入了2005年至2024年的前瞻性和回顾性研究、临床试验及病例报告。使用的关键词为“直肠间隔器”“妇科癌症放疗”和“水凝胶间隔器”。
直肠间隔器在减少妇科癌症直肠剂量暴露方面显示出显著的剂量学优势，尤其是在近距离放疗中。然而，间隔器置入区域与临床靶区（CTV）重叠，在治疗计划中需要仔细考虑。直肠间隔器在SBRT中的应用仍在发展，可用的临床数据有限。局限性包括成本、移位风险和患者不适。此外，成本效益和在临床实践中的常规应用需要进一步研究。
虽然直肠间隔器在降低毒性方面有显著益处，但其在治疗精度方面的作用仍有争议。需要进一步研究以优化患者选择和成本效益。未来的研究应专注于完善患者选择标准、提高间隔器稳定性以及评估长期临床和经济影响。
