title: Human collagen injections to reduce rectal dose during radiotherapy.
abstract: OBJECTIVE
  The continuing search for interventions, which address the incidence and grade of rectal toxicities associated with radiation treatment of prostate cancer, is a major concern. We are reporting an investigational trial using human collagen to increase the distance between the prostate and anterior rectal wall, thereby decreasing the radiation dose to the rectum.
  
  
  METHODS
  This is a pilot study evaluating the use of human collagen as a displacing agent for the rectal wall injected before starting a course of intensity-modulated radiotherapy (IMRT) for prostate cancer. Using a transperineal approach, 20 mL of human collagen was injected into the perirectal space in an outpatient setting. Computerized IMRT plans were performed pre- and postcollagen injection, and after a patient completed their radiotherapy, to determine radiation dose reduction to the rectum associated with the collagen injection. Computed tomography scans were performed 6 months and 12 months after completing their radiotherapy to evaluate absorption rate of the collagen. All patients were treated with IMRT to a dose of 75.6 Gy to the prostate.
  
  
  RESULTS
  Eleven patients were enrolled into the study. The injection of human collagen in the outpatient setting was well tolerated. The mean separation between the prostate and anterior rectum was 12.7 mm. The mean reduction in dose to the anterior rectal wall was 50%. All men denied any rectal symptoms during the study.
  
  
  CONCLUSIONS
  The transperineal injection of human collagen for the purpose of tissue displacement is well tolerated in the outpatient setting. The increased separation between the prostate and rectum resulted in a significant decrease in radiation dose to the rectum while receiving IMRT and was associated with no rectal toxicities.
authors.affiliation: Department of Radiation Oncology, Cancer Center of North Dakota, Grand Forks, ND, USA. noyes@cancercenternd.com
authors.forename: William R
authors.initials: WR
authors.lastname: Noyes
authors.forename: Charles C
authors.initials: CC
authors.lastname: Hosford
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schultz
mesh_terms: D003094:Collagen / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D058958:Organs at Risk / Q000528:radiation effects*; D010865:Pilot Projects; D011467:Prostate / Q000033:anatomy & histology; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012007:Rectum / Q000033:anatomy & histology / Q000528:radiation effects*
chemical_list: D003094:Collagen