Elsevier

The Lancet Oncology

Volume 22, Issue 1, January 2021, Pages 11-13
The Lancet Oncology

Comment
Considering benefit and risk before routinely recommending SpaceOAR

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    SpaceOAR is a biodegradable hydrogel matrix developed for protecting the rectum against iatrogenic radiation injury during prostate cancer radiation therapy [1–3].

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    It is a rather safe and minimally invasive procedure that allows a significant decrease of the dose to the rectum (Chapet et al., 2014; Boissier et al., 2017). As such, it can be considered an option before prostate SBRT, although some authors have expressed reservations about general applicability (Hall et al., 2021). We recommend that the bladder be delineated as a full organ as well.

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    Since that time, use of the perirectal spacer for prostate radiation therapy has increased, with exploration of its use in different radiation therapy techniques including stereotactic body radiation therapy (SBRT) and brachytherapy.4-11 Use of the perirectal spacer is not without any associated toxicity, as a recent analysis using the Food and Drug Administration Manufacturer and User Facility Device database described 85 reported events between May 2015 and May 2020, 69% of which were Common Terminology Criteria for Adverse Events (version 5.0) grade 3, 4, or 5.12 Although severe events are rare, the recommendation for use of a perirectal spacer in a patient with prostate cancer requires a balanced discussion surrounding the potential benefits and outlining possible risks associated with its placement/use.

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