Improving rectal dosimetry for patients with 
intermediate and high-risk prostate cancer undergoing combined high-dose-rate brachytherapy and external beam radiotherapy with hydrogel space

Michael Chao; Darren Ow; Huong Ho; Yee Chan; Daryl Lim Joon; Sandra Spencer; Nathan Lawrentschuk; Mario Guerrieri; Trung Pham; Kevin McMillan; Alwin Tan; Farshad Foroudi; Johann Tang; Jason Wasiak; Madalena Liu; George Koufogiannis; Chee Wee Cham; Damien Bolton

doi:10.5114/jcb.2019.82836

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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abstract:

Original paper

Improving rectal dosimetry for patients with intermediate and high-risk prostate cancer undergoing combined high-dose-rate brachytherapy and external beam radiotherapy with hydrogel space

Michael Chao

,

Darren Ow

,

Huong Ho

,

Yee Chan

,

Daryl Lim Joon

,

Sandra Spencer

,

Nathan Lawrentschuk

,

Mario Guerrieri

,

Trung Pham

,

Kevin McMillan

,

Alwin Tan

,

Farshad Foroudi

,

Johann Tang

,

Jason Wasiak

,

Madalena Liu

,

George Koufogiannis

,

Chee Wee Cham

,

Damien Bolton

J Contemp Brachytherapy 2019; 11, 1: 8–13

DOI: https://doi.org/10.5114/jcb.2019.82836

Online publish date: 2019/02/11

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AMA

Chao M, Ow D, Ho H, et al. Improving rectal dosimetry for patients with 
intermediate and high-risk prostate cancer undergoing combined high-dose-rate brachytherapy and external beam radiotherapy with hydrogel space. Journal of Contemporary Brachytherapy. 2019;11(1):8-13. doi:10.5114/jcb.2019.82836.

APA

Chao, M., Ow, D., Ho, H., Chan, Y., Joon, D.,  & Spencer, S. et al. (2019). Improving rectal dosimetry for patients with 
intermediate and high-risk prostate cancer undergoing combined high-dose-rate brachytherapy and external beam radiotherapy with hydrogel space. Journal of Contemporary Brachytherapy, 11(1), 8-13. https://doi.org/10.5114/jcb.2019.82836

Chicago

Chao, Michael, Darren Ow, Huong Ho, Yee Chan, Daryl Lim Joon, Sandra Spencer,  and Nathan Lawrentschuk et al. 2019. "Improving rectal dosimetry for patients with 
intermediate and high-risk prostate cancer undergoing combined high-dose-rate brachytherapy and external beam radiotherapy with hydrogel space". Journal of Contemporary Brachytherapy 11 (1): 8-13. doi:10.5114/jcb.2019.82836.

Harvard

Chao, M., Ow, D., Ho, H., Chan, Y., Joon, D., Spencer, S., Lawrentschuk, N., Guerrieri, M., Pham, T., McMillan, K., Tan, A., Foroudi, F., Tang, J., Wasiak, J., Liu, M., Koufogiannis, G., Cham, C.,  and Bolton, D. (2019). Improving rectal dosimetry for patients with 
intermediate and high-risk prostate cancer undergoing combined high-dose-rate brachytherapy and external beam radiotherapy with hydrogel space. Journal of Contemporary Brachytherapy, 11(1), pp.8-13. https://doi.org/10.5114/jcb.2019.82836

MLA

Chao, Michael et al. "Improving rectal dosimetry for patients with 
intermediate and high-risk prostate cancer undergoing combined high-dose-rate brachytherapy and external beam radiotherapy with hydrogel space." Journal of Contemporary Brachytherapy, vol. 11, no. 1, 2019, pp. 8-13. doi:10.5114/jcb.2019.82836.

Vancouver

Chao M, Ow D, Ho H, Chan Y, Joon D, Spencer S et al. Improving rectal dosimetry for patients with 
intermediate and high-risk prostate cancer undergoing combined high-dose-rate brachytherapy and external beam radiotherapy with hydrogel space. Journal of Contemporary Brachytherapy. 2019;11(1):8-13. doi:10.5114/jcb.2019.82836.

Purpose
To report on rectal dosimetric and toxicity outcomes of intermediate and high-risk prostate cancer patients undergoing combined high-dose-rate (HDR) brachytherapy and external beam radiotherapy (EBRT) with or without hydrogel spacer (HS) insertion.

Material and methods
A total of 97 patients were analyzed in this study, with 32 patients (33%) who had HS insertion compared with a preceding group of 65 patients (67%) without HS. HS safety, the dosimetric effects on organs at risk (rectal, urethral, penile bulb, and bladder) as well as gastrointestinal (GI) and genitourinary toxicity were evaluated and compared between the two groups.

Results
The median prostate-rectal separation achieved with HS was 10 mm (range, 5-14 mm). There were no post-operative complications following HS insertion. Patients with HS had significantly lower radiation dose to the rectum across all rectal dose volumes from rV30 to rV80, whether in absolute volume (cc) or as percentage of contoured OAR (p < 0.001). There was also significantly less acute > grade 1 GI toxicity (12.5% vs. 30.8%, p = 0.05) and a trend towards less late grade 1 GI toxicity (0% vs. 7.7%; p = 0.11) in the HS group compared to the non-HS group.

Conclusions
Insertion of HS in prostate cancer patients receiving combined HDR and EBRT is safe and has resulted in a significant radiation dose reduction to the rectum, resulting in significantly less acute GI toxicity and a trend towards less late GI toxicity.

keywords:

Improving rectal dosimetry for patients with intermediate and high-risk prostate cancer undergoing combined high-dose-rate brachytherapy and external beam radiotherapy with hydrogel space

Michael Chao , Darren Ow , Huong Ho , Yee Chan , Daryl Lim Joon , Sandra Spencer , Nathan Lawrentschuk , Mario Guerrieri , Trung Pham , Kevin McMillan , Alwin Tan , Farshad Foroudi , Johann Tang , Jason Wasiak , Madalena Liu , George Koufogiannis , Chee Wee Cham , Damien Bolton

prostate cancer, hydrogel spacer, high-dose-rate, brachytherapy, rectal protection