Comparing 3-Year Rectal Spacer Outcomes Across Technologies

In this video, Martin T. King, MD, PhD, describes what the 3-year data add to the evidence base: a continued reduction in late grade 2 or higher GI toxicity, outcomes he says carry meaningful implications for patients.1 He acknowledges some ongoing debate about what proportion of patients are truly susceptible to these toxicities and says further research is needed to better define that population, but argues that minimizing this risk across all patients could still be of considerable value.

Comparing these 3-year results with previously published data, he notes that the reduction in late grade 2 or higher GI toxicity is consistent with earlier findings from a PEG hydrogel spacer trial, even though that trial used conventionally fractionated radiation therapy rather than the hypofractionated regimen used in his study. He describes the overall agreement in toxicity outcomes as reassuring. Asked whether he sees differences in consistency, reproducibility, or clinical outcomes across spacer technologies, he says nothing stands out to him at this time.

He then turns to how clinicians might choose among the now 3 FDA-approved rectal spacer products, saying that ultimately clinicians should use whichever spacer they are most comfortable and familiar with. For his own preference, the hyaluronic acid spacer evaluated in this trial (Barrigel), King cites its ease of use and its ability to be sculpted: It can be placed symmetrically, adjusted to add extra spacing toward the prostate apex, and reversed with hyaluronidase if there is evidence of rectal wall infiltration. Those handling characteristics, he says, are the factors that matter most to him in practice.

In the next episode, "Safety and Patient Selection for Rectal Spacer Use," King turns to the trial's safety findings and explains how the 3-year data should guide which patients are appropriate candidates for a rectal spacer.