Autologous fat transfer as prostate-rectal spacer: Technique description and early results
Purpose: Several attempts have been made to increase the distance between the prostate and the rectum through injection of different synthetic compounds, generating space between organs. To report an original technique to increase the distance between the rectum and the prostate, by autologous fat implantation into the rectoprostatic space, with the aim of providing physical dosimetry protection and rectal dose sparing.
Methods: We prospectively evaluated twelve patients subjected to autologous fat implantation as recto-prostatic spacer subsequently receiving prostate either radical (n = 6), or salvage brachytherapy for local recurrence after external beam radiation therapy (EBRT) (n = 6). Standard permanent prostate brachytherapy seed implantation was performed through transperineal approach and under transrectal ultrasonography (TRUS) and template guidance. Prescribed D90 dose for Iodine - 125 monotherapy was 140 - 160 Gy, reduced by 30% for rescue cases to obtain a Rectum V100 under 1 cc.
Results: Lipo-transfer was completed in all 12 patients. Control CT scan at 1 month showed average distances of: 10.7 mm (range) (2.8 - 15.9 mm), 7.6 (1.8 - 11.6 mm) and 6.8 (4.2 - 8.3) mm at prostate base, middle and apex, respectively. Shortest separation distance observed was at apex and midline, while largest was observed the sides and at seminal vesicles level. Control CT at 3 months showed average distances of 9.6 mm (1.9 - 14.6 mm), 6.3 mm (1.8 - 10.2 mm) and 5.4 mm (3.8 - 7.2 mm) at prostate base, middle and apex, respectively. Most complications were minor.
Conclusion: Autologous fat transfer is a feasible and simple procedure for experienced practitioners with low complication rates, which allows dose escalation to the prostate.
Zelefsky MJ, Reuter EV, Fucs Z, et al. Influence of Local Tumor Control on distant metastasis and cancer-related mortality after external beam radiotherapy for prostate cancer. J Urol. 2008;179(4):1368-73.
Zietman AL, Bae K, Slater JD, et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: Long-term results from proton radiation oncology group/American college of radiology 95-09. J Clin Oncol. 2010 Mar1;28(7):1106-11.
Kinsella TJ, Bloomer WD. Tolerance of the intestine to radiation therapy. Surg Gynecol Obstet. 1980 Aug;151(2):273-84.
Moore E, Magrino T, Johnstone P. Rectal bleeding after radiation therapy for prostate cancer: endoscopic evaluation. Radiology. 2000 Oct;217(1):215-8.
Cho KH, Chung KKL, Levitt SH. Proctitis after conventional external radiation therapy for prostate cancer: importance of minimizing posterior rectal dose. Radiology. 1995 Jun;195(3):699-703.
Hatiboglu G, Pinkawa M, Vallee PJ, et al. Application technique: Placement of a prostate-rectum spacer in men undergoing prostate radiation therapy. BJU Int. 2012;110(11b):E647-E652.
Prada PJ, Fernández J, Martinez AA, et al. Transperineal injection of hyaluronic acid in anterior perirectal fat to decrease rectal toxicity from radiation delivered with intensity modulated brachytherapy or EBRT for prostate cancer patients. Int J Radiat Oncol Phys. 2007;69(1):95-102.
Chapet O, Udrescu C, Devonec M, et al. Prostate hypofractionated radiation therapy: Injection of hyaluronic acid to better preserve the rectal wall. Int J Radiat Oncol Phys. 2013;86(1):72-6.
Heikkilä VP, Kärnä A, Vaarala MH. DuraSeal as a spacer to reduce rectal doses in low-dose-rate brachytherapy for prostate cancer. Radiotherapy and Oncology. 2014;112(2):233-6.
Davis BJ1, Horwitz EM, Lee WR, et al. American brachytherapy society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy. Brachytherapy. 2012;11(1):6-19.
Coleman S. Hand Rejuvenation with structural fat grafting. Plast. Reconstr. Surg. 2002;110(7):1731-44.
Ammar H, Eldebawy E, Maarouf E, et al. Evaluation of the peripheral dose and the conformity index for three stereo-tactic radiotherapy techniques: Arcs, noncoplanar fixed fields and intensity modulation. Int J Cancer Ther Oncol. 2014;2(4):02042.
Alongi F, De Bari B, Campostrini F, et al. Salvage therapy of intraprostatic failure after radical external beam radiotherapy for prostate cancer: a Review. Critical Review in Oncol Hemat. 2013;88(3):550-63.
Strom TJ, Wilder RB, Fernandez DC, et al. A dosimetry study of polyethylene glycol hydrogel in 200 Prostate cancer patients treated with high dose rate brachytherapy+-intensity modulated radiation therapy. Radiotherapy and Oncologyl. 2014 Apr;111(1):126-31.
Moscona R, Shoshani O, Lichtig H, et al. Viability of adipose tissue injected and treated by different methods: an experimental study in the rat. Ann Plast Surg. 1994;33(5):500-06.
Shiffman M, Mirafati S. Fat transfer techniques: the effect of harvest and transfer methods in adipocyte viability and review of the literature. Dermatol Surg. 2001 Sep;27(9):819-26.
Strem BM, Hicok KC, Zhu M, et al. Multipotential differentiation of adipose tissue-derived stem cells. Keio J Med. 2005 Sep;54(3):132-41.
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