Rectum and bladder spacing in cervical cancer brachytherapy using a novel injectable hydrogel compound

PURPOSE: The aim of this study was to evaluate injection of a novel hydrogel (TracelT; Augmenix, Waltham, MA) between the cervix, rectum, and bladder in female cadavers compared with, and in addition to, the current standard of gauze packing, for organ-at-risk sparing in cervical cancer brachytherapy planning. METHODS AND MATERIALS: This brachytherapy cadaver study used T2-weighted MRI and CT imaging to compare three scenarios: (1) gauze packing alone, (2) hydrogel.injection placed in the cervical fornices and rectovaginal septum, and (3) gauze packing in conjunction with hydrogel injection. Hydrogel distribution was evaluated. Doses to 2 cm(3) volumes (D-2cc) for the rectum, bladder, and sigmoid were collected. Statistical significance (p < 0.05) was evaluated using a two-tailed paired t test. RESULTS: Hydrogel was successfully injected to space the bladder and rectum from the cervix in all five cadavers. The spacer was easily identifiable on both CT and MRI. The use of hydrogel in addition to packing resulted in a 22% decrease in rectum D-2cc dose (p = 0.02), a 10% decrease in bladder D-2cc (p = 0.27), and no change in sigmoid D-2cc dose. No difference was observed between hydrogel only vs. gauze packing only. CONCLUSIONS: Our results revealed a significant clinically meaningful decrease in rectal D-2cc associated with the use of hydrogel in addition to gauze packing TracelT hydrogel holds promise as a spacer in cervical cancer therapy. (C) 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.