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Space OAR(organs at risk)

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Prostate Cancer
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Posted 8/29/2015 2:55 AM (GMT 0)
Considering IRMT soon and worried about side effects. Read about this product that's FDA approved and has been used for radiation on prostate patients. Its a gel that separates the prostate from the rectum so to put the rectum area out of the radiation blast area. It keeps it separate for about 3 months then is absorbed after 6 months. Seems like the right thing to do, as long as the product itself isn't toxic(which they claim as safe). Now I find out from Kaiser if they will pay for something that reduces side effects to the rectum area. They have already turned me down on Proton beam therapy. Anyone familiar with Space OAR?
Posted 8/29/2015 5:00 AM (GMT 0)
I looked into it, but was not impressed. It had no impact on acute rectal toxicity, and very little on late term rectal toxicity, which is already quite low with modern IGRT/IMRT. It's value may be for those who have inflammatory bowel disease, and other unusual abnormalities that put them at risk. Plus, it cost almost $2,000 in Europe and probably a lot more in the US. I doubt Kaiser would pay for it, but if they do please let us know. Here's the article:

SpaceOAR hydrogel decreases rectal radiation dose, but is it worthwhile?

If you want to reduce rectal SEs, you may be better off with SBRT, according to a new study:

Seeds? IMRT? SBRT? Read this before deciding.

You may have a problem getting SBRT through Kaiser. They offer it in some places but not in others.
Posted 8/29/2015 5:01 AM (GMT 0)
They have just started using the SpaceOAR hydrogel at the Cleveland Clinic for SBRT. It was discussed in our meeting with the RO last week. They will most likely use it in conjunction with a rectal balloon.

We are waiting on the insurance approval for the SBRT. Once we get that, we will have a follow up meeting to discuss details of the procedure.
Posted 8/29/2015 4:40 PM (GMT 0)
Suzhtz-

Does Cleveland Clinic use continuous intra-fractional motion tracking with on-board stereoscopic X-rays or radiowave GPS (for fiducials or Calypso, respectively)? I know some SBRT systems (e.g., Elekta) rely on prostate stabilization with a rectal balloon instead. I don't know whether either approach is better than the other. Proton has been using the balloon for years, seemingly to good effect. It makes sense to me that with a balloon in men with little visceral fat, a spacer may help prevent the pressing of the rectum into the prostate.

- Allen
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