ArticleRadiation oncology journal2026
Morphological variation in rectal hydrogel spacer one month after insertion during low-dose-rate brachytherapy for prostate adenocarcinoma.
Article in Radiation oncology journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to develop and validate a 10-point, threshold-based variation score (VS) that integrates magnetic resonance imaging (MRI)-derived spacer morphology and assesses its association with rectal dose after low-dose-rate (LDR) prostate brachytherapy. MATERIALS AND
methodsWe retrospectively studied 149 men treated with iodine-125 LDR brachytherapy and polyethylene-glycol spacers (August 2022-April 2023). Using day 30 fused computed tomography-MRI, the VS assigned one point each for total volume >5 mL; hemisphere volumes (apex, base, left, and right) >5 mL; midgland thickness >5 mm; and thickness >5 mm 1-cm toward apex, base, left, and right. Univariable linear regression tested VS versus change in rectal D1cc (maximum dose to 1 mL). Bonferroni-adjusted Fisher's exact tests evaluated component differences across prespecified VS thresholds (≥6, ≥8, and 10).
resultsMedian rectal D1cc decreased from 92.4% pre-spacer to 53.4% of prescription at day 30. Each one-point higher VS was associated with 5.4 Gy lower D1cc (95% confidence interval, 3.4 to 7.4; p < 0.001, R² = 0.166). Threshold analyses identified key contributors: midgland separation distinguished VS <6 from 6-7 (adequacy 57%→100%; adjusted p = 0.026); uniform directional thickness, especially apical, distinguished 6-7 from 8-9 (22%→91%; adjusted p < 0.001); apical volume >5 mL was required for VS = 10 (19%→100%; adjusted p < 0.001).
conclusionVS is a simple, objective metric linking spacer morphology with rectal dose reduction. Threshold-oriented targets, midgland separation for VS ≥ 6, uniform thickness for VS ≥ 8, and robust apical volume for VS = 10, may guide technical optimization and quality assurance in prostate LDR brachytherapy.
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