St Luke’s Cancer Centre, Royal Surrey County Hospital

Royal Surrey introduces rectal sparing hydrogel as part of its prostate brachytherapy service

St Luke’s Cancer Centre, part of the Royal Surrey County Hospital NHS Foundation Trust, has transformed the way it delivers prostate brachytherapy with the use of SpaceOAR® hydrogel from Oncology Systems Limited. The hydrogel, placed between the prostate and rectum, has enabled the Cancer Centre to provide prostate brachytherapy to patients with cases that would usually have been considered a contraindication or those who have previously received external beam radiotherapy (EBRT). The Centre can now minimise the risk of radiation to the rectum, enabling it to offer life-changing brachytherapy treatment to a greater number of men.

The hydrogel is injected as a liquid between the prostate and rectum under ultrasound guidance. For St Luke’s Cancer Centre, insertion takes just a few minutes and forms part of existing brachytherapy treatment, negating the need for additional operations and general anaesthetic. Once injected, the liquid solidifies into a hydrogel that creates a temporary space between the prostate and rectum. The intent is to position the anterior rectal wall away from the prostate during radiotherapy and reduce the radiation dose delivered to the anterior rectum. The hydrogel maintains space for about three months and then liquefies, allowing it to be naturally absorbed by the body in about six months.

Professor Stephen Langley, Clinical Director for Urology at St Luke’s Cancer Centre comments, “SpaceOAR acts as a natural extension to our existing brachytherapy treatment and in future, it would be hard to not justify using it. It has given us the confidence to treat patients with low dose rate brachytherapy who we would not usually treat, including those with inflammatory bowel disease and a salvage EBRT patient. They had few other treatment options and SpaceOAR significantly reduced the radiation dose we gave to the rectal mucosa. This is a new application for us but the results are already promising and the patients are doing very well.”

Professor Langley continues, “Above and beyond the treatment of early prostate cancer, I can see applications for patients who have had external beam radiotherapy with a brachytherapy implant too. For prostate cancer, randomised data suggests patients who have had both EBRT and brachytherapy do significantly better than those receiving EBRT alone. SpaceOAR could therefore act as a middle ground – allowing greater effectiveness than brachytherapy in isolation, but reducing the likelihood of side effects that may come with EBRT. While we are just starting to use the hydrogel, I learnt of it from my peers in Australia, who are already using it widely and have been impressed with the outcome.”

St Luke’s Cancer Centre is the biggest centre for brachytherapy treatment in Europe, attracting referrals from all over the world and has treated over three and a half thousand men to date (March 2017). The unit was started in 1998 by Dr Robert Laing and Professor Stephen Langley with a clinical team now comprising of five Consultants, two research fellows and two specialist nurses. It also has a reputation for international research with close links with the University of Surrey.