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Rectal spacers in high-dose-rate-brachytherapy: Optimizing peripheral zone radiation delivery.

Christopher A Cronkite1, David Lakomy2, Arjit Baghwala3

  • 1Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX.

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Rectal spacers (RS) in high-dose-rate brachytherapy (HDR-BT) for prostate cancer significantly increase radiation to the peripheral zone (PZ), potentially improving treatment. RS also reduce rectal and urethral radiation exposure, supporting their use in HDR-BT.

Keywords:
DosimetryHigh-dose-rate brachytherapyPeripheral zoneProstate cancerRectal spacer

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Urologic Oncology

Background:

  • Rectal spacers (RS) improve rectal dose sparing and reduce toxicity in prostate cancer radiotherapy.
  • RS enable potential prostate dose escalation, enhancing outcomes while minimizing side effects.
  • The impact of RS on peripheral zone (PZ) dosimetry in prostate brachytherapy is not well understood.

Purpose of the Study:

  • To evaluate the effect of rectal spacers (RS) on peripheral zone (PZ) dosimetry in patients undergoing high-dose-rate brachytherapy (HDR-BT) for prostate cancer.

Main Methods:

  • Retrospective analysis of 92 patients undergoing two-fraction HDR-BT for localized prostate cancer.
  • Comparison of dosimetric parameters between patients with (RS+) and without (RS-) intraoperative rectal spacers.
  • Subset analysis by prostate size and assessment of organs at risk (OAR) dosimetry.

Main Results:

  • RS use was associated with a significant increase in PZ D90 (115.65% vs. 110.25%, p < 0.0001), particularly in smaller prostates.
  • RS significantly reduced rectal radiation exposure (Dmax, V20, D80, D2cc) and urethral doses (Dmax, V110).
  • Bladder doses (V75, D80) increased with RS use.

Conclusions:

  • Rectal spacers (RS) enhance radiation delivery to the prostate peripheral zone (PZ) during high-dose-rate brachytherapy (HDR-BT).
  • RS provide significant rectal and urethral dose sparing, supporting their integration into HDR-BT protocols.
  • Further investigation is needed to determine if these dosimetric improvements translate to enhanced long-term oncologic outcomes.