Intraoperative Neurovascular Bundle Preservation With Hyaluronic Acid During Radical Brachytherapy for Localized Prostate Cancer: Technique

Abstract Background : To evaluate the reduction, the absorbed dose delivered to the neurovascular bundle (NB) in patients with localized prostate cancer treated with only HDR brachytherapy and neurovascular bundle protection with Hyaluronic acid (HA) on the side of the prostate to increase the distance from NB to the radioactive sources. Material and Methods : This is the first published report in the medical literature that study a new approach to decrease neurovascular bundle toxicity and improve quality of life for patients with prostate cancer treated with radical brachytherapy as monotherapy. Transperineal HA injection on the side of the prostate into the lateral aspect of the prostate fat was used to consistently displace several autonomic fibres and vessels the lateral wall of the prostate away from radiation sources. Results : When a protection in the form of a HA layer is placed, the reduction effect at the maximum dose is between 46% and 54% (calculated values), which means the method for protection is highly recommended. The values of the absorbed dose calculated in this project have been compared with the ones given by the treatment planning system. These calculated values are similar than the ones given by the treatment planning system (56±2). Conclusions : This newly created space decreases absorbed dose in the neurovascular bundle, calculated with the TPS and measuremed by microMOSFET due to the thickness of HA.