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Injectable Spacer Preserves Bowels During Prostate Radiotherapy

By MedImaging International staff writers
Posted on 20 Oct 2016

Image: The SpaceOAR system benefits (Photo courtesy of Augmenix).

A novel hydrogel rectal spacer used during radiotherapy (RT) for prostate cancer results in significantly less rectal toxicity and urinary incontinence, according to a new study.

Researchers at Texas Oncology (Irving, USA) reported the three-year follow-up results from a phase III trial in patients with low-intermediate risk prostate cancer who were injected with the SpaceOAR, an absorbable hydrogel rectal spacer that separates the rectum from the prostate during RT to potentially reduce the risk of adjacent organ-at-risk (OAR) injury. The researchers examined the cumulative incidence of toxicity and mean changes in quality of life (QoL) summary scores, based on previously established thresholds.

Three-year results showed that grade 1+ rectal toxicity incidence in patients with the SpaceOAR was just 2%, compared with 90% in controls. Incidence of grade 2+ rectal toxicity was 6% in the controls, with no cases of grade 2+ toxicity reported in those receiving SpaceOAR spacer. Grade 1+ urinary incontinence was lower in patients with the spacer (4%) than in controls (15%), but there was no difference in grade 2+ urinary effects between groups. The study was presented at the annual meeting of the American Society for Radiation Oncology (ASTRO), held during September 2016 in Boston (MA, USA).

“The distance between the prostate and rectum is typically 1-2 mm; a trans-perineal procedure can be used to place the hydrogel device between the prostate and the rectum, increasing the distance to approximately 1 cm, thus putting the rectum out of harm's way during radiotherapy,” said lead author and study presenter Daniel Hamstra, MD, PhD. “Rectal dosimetry was tremendously better after placement of the hydrogel spacer, and what this correlated with was a decrease in rectal toxicity. We saw significant and dramatic relative reductions of rectal dosimetry at all levels assessed.”

The SpaceOAR system, a product of Augmenix (Waltham, MA, USA), is a temporary hydrogel injected through the perineum, guided by transrectal ultrasound. The material flows into the space between the prostate and the rectum and expands within ten seconds, reducing rectum radiation during prostate RT. Shielding the rectum also permits dose escalation and hypo-fractionation, resulting in more prostate radiation, improved cancer kill rates, and fewer radiation treatment sessions. The hydrogel remains in place for three months and is then liquefied and absorbed, leaving nothing behind.

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69 (43.869018554688): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=213 ORDER BY `ordering`

70 (452.04162597656): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294766505 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (326.87187194824): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294766505 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (51.021575927734): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (82.969665527344): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (72.002410888672): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294766505 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294766505 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (33.140182495117): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 4135.1318359375): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (109.91096496582): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

105 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

106 (76.055526733398): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294766505 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (684.02290344238): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294766505 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (135.89859008789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

109 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

110 (81.062316894531): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294766505 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 2021.0742950439): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294766505 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (782.01293945312): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (!!!!! 1396.1791992188): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (141.14379882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

115 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

116 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

117 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

118 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

119 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

120 (344.99168395996): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 40003.061294556): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

123 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

124 (509.97734069824): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294766505 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294766505 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 1633929.9678802): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (145.91217041016): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (47.922134399414): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (38.14697265625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (79.154968261719): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (40.054321289062): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (35.04753112793): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (410.79521179199): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (391.96014404297): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (40.054321289062): SELECT name FROM jos_deeppockets WHERE id=213

136 (26.941299438477): SELECT name FROM jos_deeppockets WHERE id=213

137 (445.84274291992): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (371.21772766113): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

140 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

141 (!!!!! 5736.1125946045): TRUNCATE TABLE jos_trademed_module

142 (612.02049255371): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294766505 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (259.8762512207): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294766505 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (735.99815368652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

147 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

148 (!!!!! 1218.0805206299): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (106.8115234375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

150 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

151 (!!!!! 1374.0062713623): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294766505 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294766505 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (!!!!! 3919.1246032715): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

153 (46.968460083008): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

154 (34.093856811523): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (138.99803161621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

156 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294766505 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294766505 AND published='1' LIMIT 1

157 (101.08947753906): select jos_twitters.link from jos_twitters where cat=10

158 (!!!!! 9227.0374298096): select jos_facebook.link from jos_facebook where cat=10

159 (152.1110534668): select jos_google_plus.link from jos_google_plus where cat=10

160 (300.88424682617): select jos_linkedin.link from jos_linkedin where cat=10

161 (313.04359436035): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1363.99269104): insert into jos_banners_delta values (14615,'2025-05-01 03:27:02','18.216.207.192','view'),(14202,'2025-05-01 03:27:02','18.216.207.192','view'),(14203,'2025-05-01 03:27:02','18.216.207.192','view')

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