Hyaluronic acid spacer in focal prostate reirradiation: A single centre experience

Cancer Radiother. 2020 Dec;24(8):805-811. doi: 10.1016/j.canrad.2020.03.009. Epub 2020 Jun 18.


Purpose: The optimal management of locally recurrent prostate cancer after curative radiotherapy is still unknown. In this study, we evaluated the preliminary results of reirradiation using stereotactic body radiotherapy for locally recurrent prostate cancer after initial definitive local radiotherapy.

Materials and methods: Between April 2016 and February 2019, 11 patients with recurrent disease at the previously irradiated prostate were treated. Local recurrence was detected by radiological with or without functional imaging modalities including prostate multiparametric/pelvic MRI or positron-emission tomography-computerised tomography with (68Ga)-labelled prostate-specific membrane antigen performed after rising prostate specific antigen serum level during follow-up. All patients received stereotactic body radiotherapy to the recurrent nodule to a total dose of 30Gy in five fractions. Hyaluronic acid spacer was injected between prostate and rectum in seven patients to decrease the rectal dose. Acute toxicity was evaluated by using Common Terminology Criteria for Adverse Events version 4.0, and late toxicity was evaluated by using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring schema.

Results: At the diagnosis, the median age was 64 years, and the mean prostate specific antigen serum concentration was 17.7ng/mL. The median interval time between local recurrence and initial definitive radiotherapy was 63 months. Mean prostate specific antigen concentration nadir value during follow-up was 0.43ng/mL. With a median follow up of 19 months, three patients developed either local or distant relapse. One patient had grade 3 acute rectal toxicity, and one patient had grade 2 late urinary toxicity. We did not observe any acute or late toxicity due to hyaluronic acid spacer injection.

Conclusion: Reirradiation after local recurrence following initial definitive radiotherapy together with hyaluronic acid spacer use seems to be effective and safe.

Keywords: ((68)Ga)-PSMA; Acide hyaluronique; Cancer; Espaceur rectal; Hyaluronic acid; Prostate; Radiotherapy; Radiothérapie; Rectal spacer; Reirradiation; Réirradiation; Toxicity; Toxicité.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biocompatible Materials / administration & dosage*
  • Dose Fractionation, Radiation
  • Humans
  • Hyaluronic Acid / administration & dosage
  • Hyaluronic Acid / analogs & derivatives*
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / blood
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / radiotherapy*
  • Organs at Risk / diagnostic imaging
  • Organs at Risk / radiation effects
  • Positron Emission Tomography Computed Tomography / methods
  • Prostate / diagnostic imaging
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / diagnostic imaging
  • Prostatic Neoplasms / radiotherapy*
  • Radiation Injuries / prevention & control
  • Radiosurgery / methods
  • Radiotherapy, Image-Guided / methods
  • Re-Irradiation / methods*
  • Rectum / diagnostic imaging
  • Rectum / radiation effects
  • Salvage Therapy / methods
  • Time Factors
  • Tumor Burden
  • Viscosupplements / administration & dosage*


  • Biocompatible Materials
  • Viscosupplements
  • hylan
  • Hyaluronic Acid
  • Prostate-Specific Antigen