Barrigel Spacer Injection Technique

The combination of intensity modulated radiation therapy and image-guided radiation therapy has improved the ability to spare normal tissue during definitive radiation therapy for organ-confined prostate cancer, allowing dose escalation that reduces recurrence rates and toxicities associated with treatment. However, the close proximity of the posterior prostate to the anterior rectal wall often results in high rectal doses that image-guided radiation therapy alone cannot remedy. To address this issue, biodegradable inflatable balloons, polyethylene-glycol-based hydrogel,1-3 and more recently hyaluronic acid (HA),4 have been used to improve rectal dose-volume histograms by displacing the anterior rectal wall away from the prostate gland, thus creating a radioprotective space between the prostate and rectum.