Rectal Spacer Reduces Gastrointestinal Side Effects of Radiation Post Radical Prostatectomy
<b>Objectives:</b> Our objective was to assess the rate of complications and gastrointestinal adverse effects of rectal spacer insertion for salvage post prostatectomy radiation therapy. <b>Methods:</b> A retrospective observational study was performed. Between September 2018...
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MDPI AG
2024-04-01
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| Series: | Société Internationale d’Urologie Journal |
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| author | Anne Hong Damien Bolton Trung Pham David Angus David Pan Daryl Lim Joon Alwin Tan Kevin McMillan Yee Chan Paul Manohar Joe Thomas Huong Ho Peter Orio Emily Holt Margaret Cokelek Nathan Lawrentschuk Farshad Foroudi Michael Chao |
| author_facet | Anne Hong Damien Bolton Trung Pham David Angus David Pan Daryl Lim Joon Alwin Tan Kevin McMillan Yee Chan Paul Manohar Joe Thomas Huong Ho Peter Orio Emily Holt Margaret Cokelek Nathan Lawrentschuk Farshad Foroudi Michael Chao |
| author_sort | Anne Hong |
| collection | DOAJ |
| description | <b>Objectives:</b> Our objective was to assess the rate of complications and gastrointestinal adverse effects of rectal spacer insertion for salvage post prostatectomy radiation therapy. <b>Methods:</b> A retrospective observational study was performed. Between September 2018 and March 2022, 64 post-radical prostatectomy patients who were planned for salvage radiation therapy received a rectal spacer. The selected patients were those who had nerve-sparing prostatectomy with intrafascial or interfascial dissections (where Denonvillier’s fascia is retained). Radiation dose to the rectal wall and gastrointestinal symptoms were assessed. Symptoms were graded using the National Cancer Center Institute Common Terminology Criteria for Adverse Events v4.0 grading scheme. A total of 39 patients had pre-spacer planning computer tomography (CT) scans, and the rectal dose before and after the spacer insertion was calculated. Comparisons were made using the Student’s <i>t</i>-test, with a <i>p</i>-value < 0.05 representing statistical significance. Finally, clinicians were surveyed to rate the ease of the procedure using a 5-point Likert scale of 1 to 5 (1: very difficult, 2: difficult, 3: moderate, 4: easy, 5: very easy). <b>Results:</b> A total of 64 patients successfully underwent rectal spacer insertion. The mean age was 64.4 years (standard deviation: 5.7 years). After a median of 14 months’ (range 6 to 35) follow up, acute grade 1 and above gastrointestinal (GI) toxicities were seen in 28% of patients (grade 2 in 1.5%), and late grade 1 and above GI toxicities were seen in 12% of patients (grade 2 in 1.5%). Amongst the 39 patients with pre-spacer planning CT images, the volume of the rectum receiving 60%, 70%, 80%, 90%, and 100% of the prescribed radiation dose was reduced by 25.9%, 34.2%, 35.4%, 43.7%, and 61.7%, respectively. All dose reductions were statistically significant. The procedure was rated as “easy” or “very easy” to perform in 56% of cases. <b>Conclusions:</b> The insertion of a rectal spacer in selected patients undergoing PPRT is feasible and safe and significantly improves rectal wall radiation dosimetry in salvage post prostatectomy radiation therapy. It was accomplished in >95% of patients, increasing vesico-rectal separation from ‘immediate vicinity’ to 11 mm without any post-operative complications in experienced hands. In addition, it achieved significant reduction in rectal radiation doses, leading to low rates of acute and late grade 2 toxicity. |
| format | Article |
| id | doaj-art-c4be7124b27743eb9dba6f7107be8edb |
| institution | OA Journals |
| issn | 2563-6499 |
| language | English |
| publishDate | 2024-04-01 |
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| series | Société Internationale d’Urologie Journal |
| spelling | doaj-art-c4be7124b27743eb9dba6f7107be8edb2025-08-20T02:02:32ZengMDPI AGSociété Internationale d’Urologie Journal2563-64992024-04-015211112110.3390/siuj5020020Rectal Spacer Reduces Gastrointestinal Side Effects of Radiation Post Radical ProstatectomyAnne Hong0Damien Bolton1Trung Pham2David Angus3David Pan4Daryl Lim Joon5Alwin Tan6Kevin McMillan7Yee Chan8Paul Manohar9Joe Thomas10Huong Ho11Peter Orio12Emily Holt13Margaret Cokelek14Nathan Lawrentschuk15Farshad Foroudi16Michael Chao17Department of Urology, Austin Health, Melbourne, VIC 3084, AustraliaDepartment of Urology, Austin Health, Melbourne, VIC 3084, AustraliaDepartment of Urology, Monash Health, Clayton, VIC 3168, AustraliaDepartment of Urology, Austin Health, Melbourne, VIC 3084, AustraliaDepartment of Urology, Austin Health, Melbourne, VIC 3084, AustraliaOlivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC 3084, AustraliaPeninsula Private Hospital, Frankston, VIC 3199, AustraliaDepartment of Urology, Eastern Health, Box Hill, VIC 3128, AustraliaDepartment of Urology, Austin Health, Melbourne, VIC 3084, AustraliaDepartment of Urology, Monash Health, Clayton, VIC 3168, AustraliaDepartment of Urology, Eastern Health, Box Hill, VIC 3128, AustraliaGenesis Cancer Care Victoria, 36 Mt Dandenong Road, Ringwood East, VIC 3135, AustraliaDepartment of Radiation Oncology, Dana-Farber Brigham Cancer Center, Boston, MA 02115, USAGenesis Cancer Care Victoria, 36 Mt Dandenong Road, Ringwood East, VIC 3135, AustraliaGenesis Cancer Care Victoria, 36 Mt Dandenong Road, Ringwood East, VIC 3135, AustraliaDepartment of Urology, Austin Health, Melbourne, VIC 3084, AustraliaFaculty of Medicine, Health Sciences and Dentistry, The University of Melbourne, Parkville, VIC 3052, AustraliaFaculty of Medicine, Health Sciences and Dentistry, The University of Melbourne, Parkville, VIC 3052, Australia<b>Objectives:</b> Our objective was to assess the rate of complications and gastrointestinal adverse effects of rectal spacer insertion for salvage post prostatectomy radiation therapy. <b>Methods:</b> A retrospective observational study was performed. Between September 2018 and March 2022, 64 post-radical prostatectomy patients who were planned for salvage radiation therapy received a rectal spacer. The selected patients were those who had nerve-sparing prostatectomy with intrafascial or interfascial dissections (where Denonvillier’s fascia is retained). Radiation dose to the rectal wall and gastrointestinal symptoms were assessed. Symptoms were graded using the National Cancer Center Institute Common Terminology Criteria for Adverse Events v4.0 grading scheme. A total of 39 patients had pre-spacer planning computer tomography (CT) scans, and the rectal dose before and after the spacer insertion was calculated. Comparisons were made using the Student’s <i>t</i>-test, with a <i>p</i>-value < 0.05 representing statistical significance. Finally, clinicians were surveyed to rate the ease of the procedure using a 5-point Likert scale of 1 to 5 (1: very difficult, 2: difficult, 3: moderate, 4: easy, 5: very easy). <b>Results:</b> A total of 64 patients successfully underwent rectal spacer insertion. The mean age was 64.4 years (standard deviation: 5.7 years). After a median of 14 months’ (range 6 to 35) follow up, acute grade 1 and above gastrointestinal (GI) toxicities were seen in 28% of patients (grade 2 in 1.5%), and late grade 1 and above GI toxicities were seen in 12% of patients (grade 2 in 1.5%). Amongst the 39 patients with pre-spacer planning CT images, the volume of the rectum receiving 60%, 70%, 80%, 90%, and 100% of the prescribed radiation dose was reduced by 25.9%, 34.2%, 35.4%, 43.7%, and 61.7%, respectively. All dose reductions were statistically significant. The procedure was rated as “easy” or “very easy” to perform in 56% of cases. <b>Conclusions:</b> The insertion of a rectal spacer in selected patients undergoing PPRT is feasible and safe and significantly improves rectal wall radiation dosimetry in salvage post prostatectomy radiation therapy. It was accomplished in >95% of patients, increasing vesico-rectal separation from ‘immediate vicinity’ to 11 mm without any post-operative complications in experienced hands. In addition, it achieved significant reduction in rectal radiation doses, leading to low rates of acute and late grade 2 toxicity.https://www.mdpi.com/2563-6499/5/2/20salvage radiationprostate cancerrectal spacerrectal toxicitygastrointestinal side effects |
| spellingShingle | Anne Hong Damien Bolton Trung Pham David Angus David Pan Daryl Lim Joon Alwin Tan Kevin McMillan Yee Chan Paul Manohar Joe Thomas Huong Ho Peter Orio Emily Holt Margaret Cokelek Nathan Lawrentschuk Farshad Foroudi Michael Chao Rectal Spacer Reduces Gastrointestinal Side Effects of Radiation Post Radical Prostatectomy Société Internationale d’Urologie Journal salvage radiation prostate cancer rectal spacer rectal toxicity gastrointestinal side effects |
| title | Rectal Spacer Reduces Gastrointestinal Side Effects of Radiation Post Radical Prostatectomy |
| title_full | Rectal Spacer Reduces Gastrointestinal Side Effects of Radiation Post Radical Prostatectomy |
| title_fullStr | Rectal Spacer Reduces Gastrointestinal Side Effects of Radiation Post Radical Prostatectomy |
| title_full_unstemmed | Rectal Spacer Reduces Gastrointestinal Side Effects of Radiation Post Radical Prostatectomy |
| title_short | Rectal Spacer Reduces Gastrointestinal Side Effects of Radiation Post Radical Prostatectomy |
| title_sort | rectal spacer reduces gastrointestinal side effects of radiation post radical prostatectomy |
| topic | salvage radiation prostate cancer rectal spacer rectal toxicity gastrointestinal side effects |
| url | https://www.mdpi.com/2563-6499/5/2/20 |
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