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      A case report: Retrograde arterial embolization of locally-injected SpaceOAR hydrogel material into the right common iliac artery bifurcation

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          Abstract

          Biodegradable hydrogel-based matrices are becoming more widely utilized for a variety of medical applications, including SpaceOAR which is a hydrogel injected into the recto-prostatic space under ultrasound guidance to protect the rectum during prostate radiation therapy. Although a greater number of these procedures are being performed, there are no case reports on the potential complications which may result. In this report, we present the first case of retrograde embolization of SpaceOAR hydrogel into the right common iliac artery during routine office administration, as well as subsequent interventional angiography, inpatient and outpatient management, and clinical and imaging results at 1.5-month patient follow-up.

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          Most cited references8

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          Transperineal injection of hyaluronic acid in the anterior perirectal fat to decrease rectal toxicity from radiation delivered with low-dose-rate brachytherapy for prostate cancer patients.

          Monitored rectal late morbidity using proctoscopy and a modified radiation therapy oncology group rectal bleeding scoring scale, in patients treated with permanent implant of I-125 and submitted to rectal protection with hyaluronic acid (HA) injecting in the perirectal fat to increase the distance between the prostate and the anterior rectal wall to decrease rectal toxicity. This is the first article looking at such injections in low-dose-rate brachytherapy patients and subsequent rectal toxicity. Between January 2005 and July 2006, a total of 69 consecutive outpatients with low- and intermediate-risk prostate cancer were enrolled in a clinical trial. First group received brachytherapy alone with I-125 and the second group received brachytherapy I-125 and protection of the rectal wall with HA. We injected 6-8cc of HA in the perirectal fat, to increase the distance between the prostate and the anterior rectal wall. Proctoscopic examinations with scoring of mucosal damage were performed according to a descriptive scale, described by Wachter et al. The median follow-up at time of endoscopy was 18 months. Toxicity measures included modified radiation therapy oncology group late bleeding toxicity grading. The hyaluronic and non-hyaluronic groups were similar for most patients, in tumor, treatment, and dosimetric characteristics. Patients treated with brachytherapy I-125 and rectal protection with HA had significantly smaller incidence of mucosal damage at the proctoscopic examinations (5% vs. 36%, p=0.002) and no macroscopic rectal bleeding (0% vs. 12%, p=0.047) than those treated with brachytherapy I-125 alone without HA. No toxicity was produced from the HA or its injection. The increased distance between the rectal wall and the prostate, as a result from the injection of HA in the perirectal fat, has significantly decreased the rectal dose from low-dose-rate brachytherapy. Patients treated with brachytherapy I-125 and protection rectal with HA had significantly smaller incidence of mucosal damage at the proctoscopic examinations and no macroscopic rectal bleeding than those treated with brachytherapy I-125 alone without HA.
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            Feasibility of and rectal dosimetry improvement with the use of SpaceOAR® hydrogel for dose-escalated prostate cancer radiotherapy.

            The aim of this study was to investigate the feasibility of injecting a temporary spacer between the rectum and the prostate and to quantify the degree of rectal dosimetric improvement that might result.
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              Considering benefit and risk before routinely recommending SpaceOAR

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                Author and article information

                Contributors
                Journal
                Radiol Case Rep
                Radiol Case Rep
                Radiology Case Reports
                Elsevier
                1930-0433
                12 December 2022
                February 2023
                12 December 2022
                : 18
                : 2
                : 719-726
                Affiliations
                [a ]Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA
                [b ]Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
                [c ]Department of Radiology, Baylor College of Medicine, 1 Baylor Plz., Houston, TX 77030, USA
                [d ]Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
                Author notes
                [* ]Corresponding author. john.yang.qiao@ 123456gmail.com
                Article
                S1930-0433(22)00129-7
                10.1016/j.radcr.2022.02.042
                9768241
                c71239e7-16e6-4caa-b94f-837b8eedde77
                Published by Elsevier Inc. on behalf of University of Washington.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 12 February 2022
                : 13 February 2022
                Categories
                Case Report

                hydrogel,spaceoar,arterial embolization,retrograde arterial embolization,interventional radiology complications,angiography

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