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Implantable Rectal Spacers in Prostate Cancer Radiation Therapy: A Systematic Review.

Julie Lippens¹, Louise Willems¹, Oleksandr Boychak²

¹Department of Human Structure and Repair, Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium.

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Summary

Implantable rectal spacers (IRSs) effectively reduce rectal radiation dose and gastrointestinal toxicity in prostate cancer patients. IRS use is linked to improved long-term bowel quality of life and a favorable safety profile.

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Area of Science:

Radiation Oncology
Medical Physics
Urology

Background:

Prostate cancer radiation therapy can cause significant rectal toxicity.
Implantable rectal spacers (IRSs) aim to mitigate this by increasing rectal-prostate separation.
Evidence on IRS efficacy and safety requires systematic review.

Purpose of the Study:

To review the literature on implantable rectal spacers (IRSs) for prostate cancer radiation therapy.
To assess IRS efficacy in reducing rectal dose and gastrointestinal (GI) toxicity.
To evaluate the safety and impact on quality of life (QoL) of IRS use.

Main Methods:

Systematic literature search (December 2024) of prospective human studies (2007-2024).
Included randomized controlled trials (RCTs) and clinical trials focusing on adverse events, rectal dose, GI toxicity, and bowel QoL.
Assessed IRS implantation, safety, and spacing efficacy.

Main Results:

RCT data available for hydrogel, hyaluronic acid, and balloon spacers; limited data for collagen.
A 1 cm rectal-prostate separation effectively spares the rectum.
IRSs demonstrate a favorable safety profile (0.96% complication rate for hydrogel) with no grade 4-5 GI toxicity reported.
IRS use is associated with improved long-term bowel QoL.

Conclusions:

Implantable rectal spacers (IRSs) can enhance prostate cancer radiation therapy outcomes.
IRS integration into clinical practice shows potential for improved patient QoL.
Patient selection is crucial to maximize IRS benefits, as not all patients may benefit equally.