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Abstract
Introduction. Improving the safety of prostate cancer (PCa) radiotherapy is the most important challenge facing modern radiation oncology. The development of a radiotherapy technique that reduces the risk of post-radiation erectile dysfunction aims to solve this problem.
Aim. To evaluate the mechanisms of dose reduction to the erectile critical organs (ErCO) during radiotherapy for PCa by perineal implantation of a paraprostatic biodegradable spacer (PBS).
Materials and methods. The trial included 20 patients with verified PCa who received stereotactic radiotherapy (SRT) with a total dose of 36.25 Gy. In the pre-radiation preparation, a perineal injection of a domestically produced spacer was performed in the volume of 6-8 ml. Four plans (80 in total) were calculated for each patient to analyse dose changes due to the use of the biopolymer: a standard plan (SP) before PBS implantation without dose reduction to the ErCO vessel (SP-1), a vessel-sparing plan (VSP) before PBS implantation (VSP-1), a standard plan after PBS implantation without dose reduction to the ErCO vessel (SP-2) and a vessel-sparing plan after PBS implantation (VSP-2).
Results. There was virtually no change in the topography of the prostate apex in relation to the basal structures of the penis. There were no significant differences in radiation dose to vascular ErCO in standard planning (SP-1 and SP-2), regardless of the use of PBS. Additional optimization to maximise dose reduction under the vessel-sparing protocol (SSP-1 and SSP-2) resulted in a significant reduction in dose to vascular ErCO compared to standard plans, and implantation of PBS enabled the lowest levels of IPA exposure to be achieved (p < 0.0001).
Conclusion. Perineal implantation of a PBS improves the effectiveness of vessel-sparing radiotherapy for PCa by temporarily displacing the anterior rectal wall relative to the prostate, providing additional opportunities to optimize spatial dose distribution.
References
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