Polyethylene glycol-based hydrogel rectal spacers for prostate brachytherapy: a systematic review with a focus on techni
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ORIGINAL ARTICLE
Polyethylene glycol‑based hydrogel rectal spacers for prostate brachytherapy: a systematic review with a focus on technique S. Vaggers1 · B. P. Rai2 · E. C. P. Chedgy1 · A. de la Taille3 · B. K. Somani1 Received: 14 May 2020 / Accepted: 13 August 2020 © The Author(s) 2020
Abstract Introduction Radiation dose to the rectum in prostate brachytherapy (PBT) can be reduced by the use of polyethylene glycol (PEG) hydrogel spacers. This reduces the rate of rectal toxicity and allows dose escalation to the prostate. Our objectives were to provide an overview of technique for injection of a PEG hydrogel spacer, reduction in rectal dosimetry, gastrointestinal toxicity and potential complications. Methods We systematically reviewed the role of PEG hydrogel spacers in PBT using the Cochrane and PRISMA methodology for all English-language articles from January 2013 to December 2019. Data was extracted for type of radiotherapy, number of patients, type of PEG-hydrogel used, mean prostate-rectum separation, rectal dosimetry, acute and late GI toxicity, procedure-related complications and the technique used for hydrogel insertion. Results Nine studies (671 patients and 537 controls) met our inclusion criteria. Of these 4 used DuraSeal® and 5 used SpaceOAR®. The rectal spacing achieved varied between 7.7-16 mm. Failure of hydrogel insertion was seen only in 12 patients, mostly related to failure of hydrodissection in patients undergoing salvage PBT. Where reported, the rectal D2 cc was reduced by between 21.6 and 52.6% and the median rectal V75% cc was reduced by between 91.8–100%. Acute GI complications were mostly limited to grade 1 or 2 toxicity (n = 153, 33.7%) with low levels of grade 3 or 4 toxicity (n = 1, 0.22%). Procedure-related complications were limited to tenesmus (0.14%), rectal discomfort (1.19%), and bacterial prostatitis (0.44%). Conclusions PEG hydrogel spacers are safe to insert. Gel insertion is easy, fast and has a low rate of failure. These studies convincingly demonstrate a significant reduction in rectal dosimetry. Although the results of spacers in reducing rectal toxicity is promising, these need to be confirmed in prospective randomised trial. Keywords Prostate · Cancer · Rectal spacer · Brachytherapy · SpaceOAR · DuraSeal · Radiotherapy
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03414-6) contains supplementary material, which is available to authorized users.
Prostate brachytherapy (PBT) is a definitive treatment for prostate cancer [1, 2]. Low-dose-rate (LDR) or highdose-rate (HDR) PBT can be used alone or in combination
* B. K. Somani [email protected]
1
University Hospital Southampton NHS Trust, Southampton, UK
S. Vaggers [email protected]
2
Freeman Hospital, Newcastle, UK
3
Department of Urology, Robotic and Miniinvasive Surgery, Assistance Publique des Hopitaux de Paris, 94000 Créteil, France
B. P. Rai [email protected] E. C. P. Chedgy edchedgy@hotmail.
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