title: Cross-linked hyaluronan gel improves the quality of life of prostate cancer patients undergoing radiotherapy.
abstract: OBJECTIVE
  To test the hypothesis that cross-linked hyaluronan gel (Hylaform) does not affect the quality of life (QOL) of prostate cancer patients undergoing radiotherapy.
  
  
  METHODS
  Thirty-five patients with early stage prostate cancer underwent high-dose-rate brachytherapy to 2200 cGy and intensity modulated radiation therapy to 5040 cGy on a prospective study. Thirty patients received a single transperineal injection of 9-mL Hylaform between the prostate and rectum under transrectal ultrasound guidance immediately before the start of radiotherapy. Hylaform increased the separation between the prostate and rectum by 6-19 mm (median, 13 mm) at the start of radiotherapy. Five patients did not receive Hylaform and served as controls. We assessed gastrointestinal-related QOL using Expanded Prostate Cancer Index Composite Bowel Bother scores immediately before the start of and during the last week of radiotherapy.
  
  
  RESULTS
  At the beginning of intensity modulated radiation therapy, daily mean rectal doses were 74±8 cGy (mean±standard deviation) and 105±25 cGy (mean±standard deviation) with vs. without Hylaform, respectively (p=0.01). Expanded Prostate Cancer Index Composite Bowel Bother scores decreased by 0±3 (mean±standard deviation) and 11±14 (mean±standard deviation) in patients who did and did not receive Hylaform, respectively (p=0.03).
  
  
  CONCLUSIONS
  Hylaform increased the separation between the prostate and rectum and decreased the mean rectal dose, thereby improving the gastrointestinal-related acute QOL of prostate cancer patients undergoing radiotherapy. Patients will be followed up long term to determine if the improvement in acute QOL also translates into an improvement in late QOL.
authors.affiliation: Cancer Center of Irvine, 16100 Sand Canyon Avenue, Irvine, CA 92618, USA. richardbwilder@yahoo.com
authors.forename: Richard B
authors.initials: RB
authors.lastname: Wilder
authors.forename: Greg A
authors.initials: GA
authors.lastname: Barme
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Gilbert
authors.forename: Richard E
authors.initials: RE
authors.lastname: Holevas
authors.forename: Luis I
authors.initials: LI
authors.lastname: Kobashi
authors.forename: Richard R
authors.initials: RR
authors.lastname: Reed
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Solomon
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Walter
authors.forename: Lucy
authors.initials: L
authors.lastname: Chittenden
authors.forename: Albert V
authors.initials: AV
authors.lastname: Mesa
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Agustin
authors.forename: Jessica
authors.initials: J
authors.lastname: Lizarde
authors.forename: Jorge C
authors.initials: JC
authors.lastname: Macedo
authors.forename: John
authors.initials: J
authors.lastname: Ravera
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Tokita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D041981:Gastrointestinal Tract / Q000503:physiopathology / Q000528:radiation effects; D005782:Gels; D006050:Gold Radioisotopes; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000523:psychology / Q000532:radiotherapy*; D011788:Quality of Life; D011832:Radiation Injuries / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology; D011879:Radiotherapy Dosage; D012007:Rectum / Q000000981:diagnostic imaging; D014463:Ultrasonography; D055675:Viscosupplements / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005782:Gels; D006050:Gold Radioisotopes; D055675:Viscosupplements; C445362:hylan-B gel; D006820:Hyaluronic Acid