Rectal retractor in prostate radiotherapy: pros and cons

Dose escalation in prostate radiotherapy (RT) have led to improved biochemical controls and reduced the risk of distant metastases. Over the past three decades, despite technological advancements in RT planning and delivery, the rectum is a dose-limiting structure in prostate RT owing to the close anatomical proximity of the anterior rectal wall (ARW) to the prostate gland. RT-induced rectal toxicities remain a clinical challenge, limiting the prescribed dose during prostate RT. To address the spatial proximity challenge by physically increasing the distance between the posterior aspect of the prostate and the ARW, several physical devices such as endorectal balloons (ERBs), rectal hydrogel spacers, and rectal retractor (RR) have been developed. Previously, various aspects of ERBs and rectal hydrogel spacers have extensively been discussed. Over recent years, given the interest in the application of RR in prostate external beam radiotherapy (EBRT), this editorial will discuss opportunities and challenges of using RR during prostate EBRT and provide information regarding which aspects of this device need attention.