Swedish Radiosurgery Center in Seattle, WA.

[Qiviut]

Considering SBRT vs IMRT. Is the Space OAR beneficial? Toxicity pros and cons for either technology?

[timotur]

I had SpaceOar for HDR-BT/IMRT and was happy with the outcome-- no SE's from it or radiation almost two years after the procedure. It gives about 12 mm separation and some studies show significant decrease in dose to the rectum. If you can find a Dr that has done the procedure at least a few dozen times, I think it's worth it. Others on here will say no, but I would read the studies and talk to your Dr before deciding for yourself.

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pubmed.ncbi.nlm.nih.gov/315...

Results: No complications were found during either the intraoperative or perioperative periods. The mean displacement distance of 11.64 mm was created, the mean value before spacer placement was 0.28 mm (P < 0.0001). The change of the prostate diameters showed a positive increase in all directions, with no significant negative change in any one direction. Regarding the change in distance between pubic symphysis and the prostate, no significant shortening trend was observed between the two groups (P = 0.14). Whereas the dosimetric parameters showed means of 0.001 and 0.026 cc for RV150 and RV100 in the spacer group, they were 0.025 and 0.318 cc, respectively, in the non-spacer group, showing a significant decrease in both parameters (P < 0.001).

[SpencerBoy11 in reply to timotur]

Had it and I agree 100%. Friend who didn't have it is suffering the radiation SE still.

[Tall_Allen]

Robert Meier there is certainly the best in the Seattle area for SBRT.

I call SpaceOAR a cure looking for a disease. In a randomized clinical trial it did not improve acute or late-term patient evaluations of rectal bother. Late-term rectal bother is just not a problem with modern day IGRT-linacs.

prostatecancer.news/2017/01...

My friend, who had an unknown focal extension, had his cancer pressed against his rectum and preserved by the gel. It grew into a big tumor later that caused him a lot of misery.

Unfortunately, doctors bill more because of it (they bill it as an in-office procedure) and insurance also pays the $3000 cost for the one injection. Unfortunately, patients ask for it. Because its use is so widespread, we are starting to see rectal ulcers and injury reports like these:

liebertpub.com/doi/10.1089/...

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

advancesradonc.org/article/...

muhc.ca/sites/default/files...

I know several top ROs who refuse to use it. It encourages laziness - it is a painstaking effort to perfectly contour the prostate and rectum, to leave minimal margins on the rectal side, and to adhere to strict rectal point-dose constraints. One RO I know questions whether compression of prostate tissue might interfere with blood perfusion and thus the radiation's effectiveness at killing the cancer (he is against balloons for the same reason).