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Clinical summary

Dosimetric Feasibility of Neurovascular Bundle-Sparing Stereotactic Body Radiotherapy with Periprostatic Hydrogel Spacer for Localized Prostate Cancer to Preserve Erectile Function

By: Hwang ME, Mayeda M, Shaish H, et al.

Thirty-five men with low- and intermediate-risk prostate cancer who underwent rectal hydrogel spacer placement and pre-, post-spacer prostate MRI studies were treated with prostate SBRT (36.25 Gy in five fractions). A prostate radiologist contoured the neurovascular bundles (NVB) for NVB-sparing radiation treatment planning. Three SBRT treatment plans were developed for each patient: (1) no NVB sparing, (2) NVB-sparing using pre-spacer MRI, and (3) NVB-sparing using post-spacer MRI.

Dosimetric feasibility bar graph.

“NVB-sparing SBRT with hydrogel spacer placement has the potential to significantly reduce the high dose delivered to the NVB. The spacer contributes to this effect by inducing a small but dosimetrically meaningful NVB displacement in the posterior direction. We believe that the described approach to offer clinically meaningful reductions in RiED warrants prospective clinical trials.”

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Limitations of this report include:

  • Study was retrospective in nature.
  • The SpaceOAR™ Hydrogel pivotal study did not use SBRT so the results may not be comparable.
  • This study was not designed or powered to make definitive claims about the benefits of a spacer.
  • These results may not be achieved with other SBRT protocols.
  • Contours of the NVB were performed by a single expert prostate radiologist.
  • This NVB-sparing technique is limited to men with visible NVB classically located posterolateral to the prostate, accounting for approximately half to two-thirds of men with prostate cancer.
  • Day-to-day variation in dose per fraction is more likely to affect the NVB than other organs-at-risk. This variability cannot be evaluated from the treatment plan. Comparison of planned NVB dose with delivered NVB dose will therefore be of clinical interest moving forward.

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Reference

  1. Hwang ME, Mayeda M, Shaish H, Elliston CD, Spina CS, Wenske S, et al. Dosimetric feasibility of neurovascular bundle-sparing stereotactic body radiotherapy with periprostatic hydrogel spacer for localized prostate cancer to preserve erectile function. Br J Radiol 2021; 94: 20200433.

SBRT was not the method used in the SpaceOAR Hydrogel single-blind Phase III trial performed to evaluate dosimetric and clinical effects of SpaceOAR Hydrogel. IG-IMRT delivered at 79.2 Gy in 1.8-Gy fractions was the method used.

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.

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