Norfolk and Norwich University Hospital Brachytherapy Team have become the first team globally to insert BARRIGEL® (Hyaluronic Acid Rectal Spacer) immediately prior to High Dose Rate (HDR) Brachytherapy treatment for Prostate Cancer on 10-06-2021.
What is Barrigel and what does it do?
The novel spacer device “Barrigel” uses NASHA technology (Non-Animal Stabilised Hyaluronic Acid) to enhance the existing space between the rectum and the prostate gland. BARRIGEL is an injectable implant used to increase the distance between the prostate and the anterior rectal wall with the intent to decrease the radiation dose to the rectal wall during prostate cancer radiation treatment. It can be injected de novo, with no need to mix different agents together, no time pressure to deploy the gel, and Barrigel can be “topped up” to optimise the rectal spacing achieved to satisfy anatomical and clinical needs. As a consequence of Barrigel’s hypo-echoic qualities, clear views of the prostate needle placement can be observed during the placement process via (Trans Rectal Ultrasound) TRUS.
What is the current process and how has this procedure impacted clinically and on the service?
Until now, rectal spacers have been implanted either during a separate additional appointment to the HDR treatment session, or after the HDR treatment due to the artefacts created by the spacer resulting in reduced and often poor visibility on TRUS. The insertion of Barrigel immediately prior to an HDR procedure can not only streamline the treatment pathway by removing a patient appointment from the schedule but can also enable the treatment team to plan in real time. Additionally with this process being delivered on the same day, immediately prior to the HDR treatment process and the treatment team can adjust needles posteriorly for better Planning Target Volume (PTV) coverage. With our case outcomes and results as evidence, we would foresee this process being made available to patients with Prostate Cancer who will undergo High Dose Rate (HDR) Brachytherapy as part of their cancer management.
Meet the team.
Dr Jenny Nobes (pictured second from left above) Dr Jenny Nobes has been a Consultant Clinical Oncologist at the Norfolk & Norwich University Hospital since 2010, and specialises in the management of prostate and skin cancers. She has developed the HDR brachytherapy service at NNUH, and has been treating men with this since 2018. In addition, she has implemented the use of rectal spacer insertion prior to prostate cancer radiation treatment. Sam Worster (pictured centre above) Sam qualified as a Therapeutic Radiographer in 2011, and has been the Advanced Practitioner Radiographer for Prostate brachytherapy at the NNUH since the service began in 2018. During this time he has also become a Prostate Cancer UK Clinical Champion, looking into improving radiotherapy treatment for men with prostate cancer.