This area is to supplement the course by adding additional facts and/or current practices that are

not covered in your lectures. There is far too much information to cover all current information
in this course so this is your chance to add something interesting and to gain knowledge from
your peers. Please answer the following question:
Is there something clinically that you have learned or read elsewhere that is associated with the
material that has been covered to date but isn't found in your lectures or readings?
Post your response and then read others posts. Please respond to at least one member of your
group. 20 Points are awarded for a well-written post and response by the deadline. Provide
references when appropriate.

SpaceOAR

Working as a therapist in a small private clinic, I was not aware there was another approach to
keep the rectum away from the radiated area. The only thing I knew was have the patients drink
about twenty ounces of water 20 to 30 minutes before treatment to fill the bladder comfortably. I
always told prostate patients to maintain a full bladder during their prostate treatment so that it
would reduce any side effects they might experience and help maintain treatment accuracy on a
daily basis. Here at my new clinical site, about two weeks ago, my preceptor was asking me if I
ever heard or knew about SpaceOAR. In fact, this procedure is very new to me and I’m very
interested to find out more about this technique.

Purpose
Prostate gland sits below the bladder and in front of the rectum in a very tight space (see figure
1).¹ SpaceOAR is a hydrogel that is injected between prostate and rectum that serves as a spacer
about 1.0-1.3 cm between the rectal wall and the prostate gland. SpaceOAR reduces rectal
radiation dose, rectal injury and complications by pushing the rectum away from the prostate
(see figure 2).¹ In fact, radiation to the rectum may cause pain, bleeding and diarrhea.

Procedure
Under ultrasound guidance, the hydrogel is injected between Denonvilliers’ fascia and the rectal
wall. Within 10 seconds the injected liquid will solidify into a firm hydrogel. This hydrogel will
remain in that space during prostate radiotherapy for about 3 months then dissolved by
hydrolysis and cleared in patient’s urine in about 6 months after injection (see figure 3).1
Benefit
According to a randomized study of 222 patients, it was found that there is a 74% reduction in
rectal V70 radiation exposure. Of these 222 patients, 76% experiences less rectal pain during
radiation treatment, 71% less rectal toxicity 15 months after treatment and 46% reduction in
bowel movement 1 year after radiation.²

Risk
The risk includes pain associated with hydrogel injection, pain or discomfort associated with
SpaceOAR hydrogel; needle penetration of the bladder, prostate, rectal wall, rectum or urethra;
injection of SpaceOAR into bladder, prostate, rectal wall, rectum or urethra; inflammatory
reaction; infection; injection of air, fluid or SpaceOAR hydrogel intravascularly; urinary
retention; rectal mucosal damage; ulcers; bleeding; constipation; and rectal urgency.²

An article written by Mariados N et al, reported that the spacer application is an effective tool to
reduce rectal irradiation, rectal toxicity severity and rates of patients experiencing declines in
bowel quality of life.³

Figure 11
 Figure 21

Figure 31
References
1. SpaceOAR website. https://www.spaceoar.com/. Accessed February 19, 2018
2. Advanced Urology Associates website. https://www.advuro.com/cancer-center/spaceoar-
frequently-asked-questions-faq/. Accessed February 19, 2018
3. Mariados N, Sylvester J, Shah D, et al. Hydrogel spacer prospective multicenter randomized
controlled pivotal trial: dosimetric and clinical effects of perirectal spacer application in men
undergoing prostate image guided intensity modulated radiation therapy. International Journal of
Radiation Oncology, Biology, and Physics. 2015 Aug 1;92(5):971-977.
https://www.ncbi.nlm.nih.gov/pubmed/26054865#. Published April 23, 2015. Accessed February
19, 2018.