Polyethylene glycol hydrogel rectal spacer implantation in patients with prostate cancer undergoing combination high-dose-rate brachytherapy and external beam radiotherapy

Brachytherapy. May-Jun 2016;15(3):283-287. doi: 10.1016/j.brachy.2015.12.007. Epub 2016 Feb 4.


Purpose: To present rectal toxicity rates in patients administered a polyethylene glycol (PEG) hydrogel rectal spacer in conjunction with combination high-dose-rate brachytherapy and external beam radiotherapy.

Methods and materials: Between February 2010 and April 2015, 326 prostate carcinoma patients underwent combination high-dose-rate brachytherapy of 16 Gy (average dose 15.5 Gy; standard deviation [SD] = 1.6 Gy) and external beam radiotherapy of 59.4 Gy (average dose 60.2 Gy; SD = 2.9 Gy). In conjunction with the radiation therapy regimen, each patient was injected with 10 mL of a PEG hydrogel in the anterior perirectal fat space. The injectable spacer (rectal spacer) creates a gap between the prostate and the rectum. The rectum is displaced from the radiation field, and rectal dose is substantially reduced. The goal is a reduction in rectal radiation toxicity. Clinical efficacy was determined by measuring acute and chronic rectal toxicity using the National Cancer Center Institute Common Terminology Criteria for Adverse Events v4.0 grading scheme.

Results: Median followup was 16 months. The mean anterior-posterior separation achieved was 1.6 cm (SD = 0.4 cm). Rates of acute Grade 1 and 2 rectal toxicity were 37.4% and 2.8%, respectively. There were no acute Grade 3/4 toxicities. Rates of late Grade 1, 2, and 3 rectal toxicity were 12.7%, 1.4%, and 0.7%, respectively. There were no late Grade 4 toxicities.

Conclusions: PEG rectal spacer implantation is safe and well tolerated. Acute and chronic rectal toxicities are low despite aggressive dose escalation.

Keywords: Brachytherapy; Cancer; HDR; IMRT; Prostate; Radiation; Rectal; Spacer; Toxicity.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brachytherapy / methods*
  • Carcinoma / radiotherapy*
  • Humans
  • Hydrogels / administration & dosage*
  • Male
  • Middle Aged
  • Organs at Risk / radiation effects
  • Polyethylene Glycols / administration & dosage*
  • Prostatic Neoplasms / radiotherapy*
  • Radiation Dosage
  • Radiation Injuries / etiology
  • Radiation Injuries / prevention & control*
  • Radiotherapy Dosage
  • Rectum / radiation effects*


  • Hydrogels
  • Polyethylene Glycols