Utilization of a stabilized hyaluronic acid spacer in SBRT for retroperitoneal cancers: A case series and dosimetric analysis

Abstract

Objectives

To evaluate the clinical indications, post-operative complications, and dosimetric impact of stabilized hyaluronic acid (sHA) spacer insertion in the retroperitoneum for stereotactic body radiation therapy (SBRT) of retroperitoneal cancers.

Patients and methods

This retrospective study analyzed two cases of SBRT for retroperitoneal lesions: a primary left renal cell carcinoma and an oligometastatic renal cell carcinoma (RCC) lesion in the right adrenal gland. In both cases, a sHA spacer was percutaneously inserted between the bowel and the lesion. The spacer was placed under laparoscopic and ultrasound guidance for the renal tumor, and under CT guidance for the adrenal lesion. The prescribed dose was 42 Gy in three fractions for the primary renal lesion and 40 Gy in five fractions for the adrenal lesion. Dosimetric parameters were evaluated in two planning scenarios: (1) without the spacer, adhering to OAR constraints, and (2) with the spacer.

Results

Spacer insertion for the primary left renal cancer significantly improved PTV D95% from 67.9 % to 99.5 % of the prescribed dose, a 46.5 % increase. PTV D99% increased from 54.5 % to 86.7 %, reflecting a 59.1 % improvement. The large bowel’s maximum dose was reduced from 28.2 Gy to 24.4 Gy, and the volume receiving 24 Gy was minimal with the spacer (0.06 cc). For the right oligometastatic adrenal lesion, despite a fourfold increase in tumor volume, post-spacer dosimetry showed improved PTV coverage without exceeding OAR constraints. No post-operative complications were observed in either case.

Conclusion

This is the first report on sHA spacer use in the retroperitoneum for SBRT. Spacer insertion near the large bowel significantly improves dosimetry, enabling higher doses to targets while keeping OAR doses within safe limits. Further research with a larger patient population is required to assess safety and for optimization of the technique for spacer placement in order to enhance clinical outcomes.