Nuhoglu, Aylin; (2020) Investigation of Pre-Rectal Spacer Gel for Prostate Cancer Patients using both Photon and Proton Beam Therapy. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Although remarkable strides forward are continually being made in the field of advanced radiotherapy, a clear area in which improvements must be made is that of radiation-induced rectal damage. Given the current requirement to improve outcomes for male patients diagnosed with high-risk prostate cancer, this study evaluated the impact of the SpaceOAR hydrogel treatment on members of this population receiving photon and comparing them with proton beam planning with the same treatment planning approach. As a comparative treatment planning study, the aim was to determine whether pre-rectal spacer gel with photon or proton beam therapy yielded the most effective outcomes for high-risk prostate cancer patients. In particular, the study sought to investigate the effectiveness of the hydrogel and dose volume relations of OARs with both photon and proton beam therapy, including alternative beam arrangements, to examine the potential of novel treatment options and to eliminate adverse side-effects. The findings indicated that, despite identical treatment planning approaches, the effect of the spacer gel on OAR differed between patients. This suggests that the manner in which the gel procedure was administered, and by whom, was relevant, particularly because the gel distribution varied according to the CT and MRI images. Additionally, the results demonstrated that the volume of spacer gel states between the rectum and prostate affected the dose-volume relation. Two imaging modalities, CT and MRI, were used prior to and following spacer gel insertion, and it was observed that the behaviour of and changes in the spacer gel over the treatment period informed the dose-volume relation. A 61.36% reduction in overall rectal dose was associated with hydrogel placement prior to proton beam planning, thereby suggesting that proton beam therapy is a promising intervention against localised high-risk prostate cancer. Although promising results were reported in this study regarding the status of proton beam therapy as a potential treatment modality for high-risk prostate cancer, future studies should seek to recruit a larger sample and ensure longer follow-up schedules to clarify the modality’s role. However, each of the articles included in this review found that proton beam therapy with SpaceOAR insertion is a suitable treatment approach for high-risk prostate cancer. Consideration of patient outcomes, particularly quality of life, also indicated that a relationship existed between quality of life and OAR doses, thereby emphasising the promise associated with this treatment. All in all, this study raises hypotheses that future research projects can test, and it highlights the importance of formulating novel therapeutic regimes for intervening in high-risk prostate cancer. This is particularly important because the treatment strategy examined in this study is not part of routine clinical practice in the UK.

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