Effectiveness of rectal displacement devices in managing prostate motion: asystematic review.

Abstract

To determine whether rectal displacement devices (RDDs) have aprostate-stabilizing effect during prostate external beam radiotherapy (EBRT). Asystematic literature search using the PubMed database from January1, 2000 to December30th, 2019 was conducted. The effect of RDDs on inter- and intra-fractional prostate displacements was extracted. From 356 articles identified via the PubMed database and hand search, 21articles were included in the systematic review. There was no randomized study. Twelve studies evaluated the role of the endorectal balloon (ERB) in managing prostate motion. Four studies reported the effect of hydrogel spacer on prostate motion. Four studies examined the effect of the rectal retractor (RR) on intra-fractional prostate motion, and only one study assessed the impact of ProSpare (Nottinghamshire, UK) in reducing prostate motion. Using an ERB significantly reduces intra-fractional prostate motion. This prostate-stabilizing effect of the ERB can translate into reduced planning target volume (PTV) margins and additional rectal dose sparing. Even with an ERB in place, inter-fractional prostate displacements are seen. As aconsequence, ERB application does not obviate daily verification; however, this is not acrucial topic because pretreatment imaging is always done nowadays. As compared with ERB, the hydrogel spacer significantly reduces rectal dose and toxicity without influencing prostate immobilization. The RR can increase prostate and rectal inter- and intra-fractional stability without aclear influence on the reduction of rectal toxicity. Finally, it is unclear whether ProSpare is asuitable device reducing prostate motion. Further study will be required to clarify whether the prostate-stabilizing effects of the ERB and RR can result in asafe reduction of PTV margins and further sparing of organs at risks, especially the rectum.