Technique of Injection of Hyaluronic Acid as a Prostatic Spacer and Fiducials Before Hypofractionated External Beam Radiotherapy for Prostate Cancer

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• 作者：Romain Boissier^a ; ^b ; ^{romain.boissier@ap-hm.fr} ; Corina Udrescu^c ; ^d ; Xavier Rebillard^e ; Jean-Etienne Terrier^a ; ^b ; Antoine Faix^e ; Olivier Chapet^c ; ^d ; David Azria^f ; Marian Devonec^a ; ^b ; Philippe Paparel^a ; ^b ; Alain Ruffion^a ; ^b
• 刊名：Urology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：99
• 期：Complete
• 页码：265-269
• 全文大小：388 K
• 卷排序：99

文摘

To describe a technique combining the implantation of fiducials and a prostatic spacer (hyaluronic acid [HA]) to decrease the rectal toxicity after an image-guided external beam radiotherapy (EBRT) with hypofractionation for prostate cancer and to assess the tolerance and the learning curve of the procedure.Materials and MethodsThirty patients with prostate cancer at low or intermediate risk were included in a phase II trial: image-guided EBRT of 62 Gy in 20 fractions of 3.1 Gy with intensity-modulated radiotherapy. A transrectal implantation of 3 fiducials and transperineal injection of 10 cc of HA (NASHA gel spacer, Q-Med AB, Uppsala, Sweden) between the rectum and the prostate was performed by 1 operator. The thickness of HA was measured at 10 points on magnetic resonance imaging to establish a quality score of the injection (maximum score = 10) and determine the learning curve of the procedure.ResultsThe quality score increased from patients 1-10, 11-20, to 21-30 with respective median scores: 7 [2-10], 5 [4-7], and 8 [3-10]. The average thicknesses of HA between the base, middle part, and apex of the prostate and the rectum were the following: 15.1 mm [6.4-29], 9.8 mm [5-21.2], and 9.9 mm [3.2-21.5]. The injection of the HA induced a median pain score of 4 [1-8] and no residual pain at mid-long term.ConclusionCreating an interface between the rectum and the prostate and the implantation of fiducials were feasible under local anesthesia with a short learning curve and could become a standard procedure before a hypofractionated EBRT for prostate cancer.