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Abstract
Introduction. Recently, modern concepts in radiobiology and radiation therapy in the treatment of prostate cancer imply a transition to hypofractionated treatment regimens. High dose-rate (HDR) brachytherapy is one of the effective methods of radiation therapy that allows to work in ultrahypofractionation modes, often using 2-3 fractions over the entire course of treatment. This creates the problem of reducing radiation exposure to critical pelvic organs. The dose to the anterior wall of the rectum during HDR brachytherapy in the treatment of prostate cancer can be significantly reduced through the use of polyacrylamide hydrogel-based spacers (PAGE).
Aim. To determine the effect of injection of a synthetic biodegradable PAGE gel into the area of Denonvilliers' fascia on dose distribution in the peripheral part of the prostate gland and the anterior wall of the rectum during HDR brachytherapy for prostate cancer.
Materials and Methods. The study included 30 patients. In all patients included in the study, multiparametric magnetic resonance imaging (mpMRI) of the small pelvis revealed the absence of a fat layer between the prostate gland and the anterior wall of the rectum at initial diagnosis. In order to divert the anterior wall of the rectum and reduce critical doses during brachytherapy, all patients underwent implantation of a volume-forming biosoluble synthetic gel based on PAGE in a volume of 5 ml. When injecting the gel into the Denonvilliers fascia, the main objective was to create a space of more than 5 mm between the prostate and the anterior wall of the rectum. A clinically significant result was a reduction in the D10 of the rectum of less than 11 Gy and a reduction in the critical dose to the rectum (V crit. rect.) of less than 10 %. To assess the migration of the gel spacer and to identify cases of infection and inflammation in the area of the gel insertion, all patients underwent MRI of the small pelvis 3 months after the end of brachytherapy.
Results. A clinically significant result was achieved in 96.6 % (29 out of 30) of patients. Vcrit. rectum (intestinal volume that received a critical dose) after gel administration was significantly lower than before administration and amounted to 5.6 ± 4.1 % (0.1-14.5 %). A positive result was also noted for rectal D10 (maximal dose per 10% of rectal volume). Before and after gel administration, the average D10 was 10.9 and 8.8 Gy, respectively.
Conclusion. Polyacrylamide-based hydrogel spacers are safe to insert. Administration of the gel is simple, quick and has a low complication rate. Retracting the anterior wall of the rectum away from the prostate allows optimisation of dose distribution during high dose rate brachytherapy.
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