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Radiation Dose to the Rectum With Definitive Radiation Therapy and Hydrogel Spacer Versus Postprostatectomy Radiation Therapy

PURPOSE: Management options for localized prostate cancer include definitive radiation therapy (RT) or radical prostatectomy, with a subset of surgical patients requiring adjuvant or salvage RT after prostatectomy. The use of a peri-rectal hydrogel spacer in patients receiving definitive RT has been...

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Autores principales: Yang, Daniel X., Verma, Vivek, An, Yi, Yu, James B., Sprenkle, Preston C., Leapman, Michael S., Park, Henry S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718530/
https://www.ncbi.nlm.nih.gov/pubmed/33305083
http://dx.doi.org/10.1016/j.adro.2020.08.015
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author Yang, Daniel X.
Verma, Vivek
An, Yi
Yu, James B.
Sprenkle, Preston C.
Leapman, Michael S.
Park, Henry S.
author_facet Yang, Daniel X.
Verma, Vivek
An, Yi
Yu, James B.
Sprenkle, Preston C.
Leapman, Michael S.
Park, Henry S.
author_sort Yang, Daniel X.
collection PubMed
description PURPOSE: Management options for localized prostate cancer include definitive radiation therapy (RT) or radical prostatectomy, with a subset of surgical patients requiring adjuvant or salvage RT after prostatectomy. The use of a peri-rectal hydrogel spacer in patients receiving definitive RT has been shown to reduce rectal doses and toxicity. However, in the postprostatectomy setting, a hydrogel spacer cannot be routinely placed. Therefore, we sought to compare rectal dosimetry between definitive RT with a hydrogel spacer versus postoperative RT. METHODS AND MATERIALS: We identified patients with prostate cancer who underwent conventionally fractionated RT. Rectal dosimetry was evaluated between 2 groups: definitive RT with a hydrogel spacer (79.2 Gy, group 1) and postoperative RT (70.2 Gy, group 2). Rectal dosimetry values were tabulated and compared using Mann-Whitney U test. We implemented a Bonferroni correction to account for multiple comparisons (threshold P < .005). Linear regression analysis evaluated predictors of candidate rectal dose-volume parameters. RESULTS: We identified 51 patients treated during years 2017 to 2018; 16 (31%) and 35 (69%) patients were included in groups 1 and 2, respectively. The rectal volume receiving ≥65 Gy (V65) was significantly lower in group 1 (median, 2.1%; interquartile range, 0.9%-3.1%) than in group 2 (10.7%, 6.6%-14.5%) (P < .001). Use of a hydrogel spacer in the definitive setting was independently associated with lower V65 (P < .001). Similar results were found for V60, V55, V50, and V45 (P < .005 for all). CONCLUSIONS: Rectal dosimetry is more favorable for definitive RT (79.2 Gy) with a hydrogel spacer compared with postoperative RT (70.2 or 66.6 Gy). This may inform shared decision-making regarding primary management of prostate cancer, especially among patients at high risk of needing postoperative RT after prostatectomy.
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spelling pubmed-77185302020-12-09 Radiation Dose to the Rectum With Definitive Radiation Therapy and Hydrogel Spacer Versus Postprostatectomy Radiation Therapy Yang, Daniel X. Verma, Vivek An, Yi Yu, James B. Sprenkle, Preston C. Leapman, Michael S. Park, Henry S. Adv Radiat Oncol Scientific Article PURPOSE: Management options for localized prostate cancer include definitive radiation therapy (RT) or radical prostatectomy, with a subset of surgical patients requiring adjuvant or salvage RT after prostatectomy. The use of a peri-rectal hydrogel spacer in patients receiving definitive RT has been shown to reduce rectal doses and toxicity. However, in the postprostatectomy setting, a hydrogel spacer cannot be routinely placed. Therefore, we sought to compare rectal dosimetry between definitive RT with a hydrogel spacer versus postoperative RT. METHODS AND MATERIALS: We identified patients with prostate cancer who underwent conventionally fractionated RT. Rectal dosimetry was evaluated between 2 groups: definitive RT with a hydrogel spacer (79.2 Gy, group 1) and postoperative RT (70.2 Gy, group 2). Rectal dosimetry values were tabulated and compared using Mann-Whitney U test. We implemented a Bonferroni correction to account for multiple comparisons (threshold P < .005). Linear regression analysis evaluated predictors of candidate rectal dose-volume parameters. RESULTS: We identified 51 patients treated during years 2017 to 2018; 16 (31%) and 35 (69%) patients were included in groups 1 and 2, respectively. The rectal volume receiving ≥65 Gy (V65) was significantly lower in group 1 (median, 2.1%; interquartile range, 0.9%-3.1%) than in group 2 (10.7%, 6.6%-14.5%) (P < .001). Use of a hydrogel spacer in the definitive setting was independently associated with lower V65 (P < .001). Similar results were found for V60, V55, V50, and V45 (P < .005 for all). CONCLUSIONS: Rectal dosimetry is more favorable for definitive RT (79.2 Gy) with a hydrogel spacer compared with postoperative RT (70.2 or 66.6 Gy). This may inform shared decision-making regarding primary management of prostate cancer, especially among patients at high risk of needing postoperative RT after prostatectomy. Elsevier 2020-09-15 /pmc/articles/PMC7718530/ /pubmed/33305083 http://dx.doi.org/10.1016/j.adro.2020.08.015 Text en © 2020 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Scientific Article
Yang, Daniel X.
Verma, Vivek
An, Yi
Yu, James B.
Sprenkle, Preston C.
Leapman, Michael S.
Park, Henry S.
Radiation Dose to the Rectum With Definitive Radiation Therapy and Hydrogel Spacer Versus Postprostatectomy Radiation Therapy
title Radiation Dose to the Rectum With Definitive Radiation Therapy and Hydrogel Spacer Versus Postprostatectomy Radiation Therapy
title_full Radiation Dose to the Rectum With Definitive Radiation Therapy and Hydrogel Spacer Versus Postprostatectomy Radiation Therapy
title_fullStr Radiation Dose to the Rectum With Definitive Radiation Therapy and Hydrogel Spacer Versus Postprostatectomy Radiation Therapy
title_full_unstemmed Radiation Dose to the Rectum With Definitive Radiation Therapy and Hydrogel Spacer Versus Postprostatectomy Radiation Therapy
title_short Radiation Dose to the Rectum With Definitive Radiation Therapy and Hydrogel Spacer Versus Postprostatectomy Radiation Therapy
title_sort radiation dose to the rectum with definitive radiation therapy and hydrogel spacer versus postprostatectomy radiation therapy
topic Scientific Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718530/
https://www.ncbi.nlm.nih.gov/pubmed/33305083
http://dx.doi.org/10.1016/j.adro.2020.08.015
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