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Analysis 1: Trade Publication

When conducting research, it is evident that trade magazines and peer reviewed journals

have their differences, which is seen at first glance, by the writing style and overall setup. When

people visit the trade magazine website Radiation Today, the readers are drawn in by the user

friendly tabs, colorful pictures and ads, and even a live twitter feed going down the side of the

page. A peer reviewed journal article, such as from Radiation Oncology, looks more scholarly

and more organized with less "fluff" and color. In the research journal, there is detailed graphs

and images displaying dose distributions. It is apparent that the peer reviewed journal is going to

provide much more useful information than the trade magazine. My analysis is going to cover a

summary of the article, strengths and weaknesses, and how professionals can apply the

information given. The trade Magazine Radiation Today will be the first analysis covered, about

an article titled "Target on Therapy: Hydrogel Reduces Prostate Cancer Treatment

Complications" written by Edward M. Soffen, MD. I chose this topic because SpaceOAR is now

starting to be implemented in the radiation oncology department I work at.

After reading the article, I can divide it into two sections: a general summary of prostate

cancer and then a general summary of hydrogel. The first half states an overview of prostate

cancer, treatment, and screening. The second half finally mentions the need for hydrogel and its

purpose: to protect the rectal tissue by creating a 1 cm barrier between the prostate and rectum

during radiation therapy.1 Then it briefly mentions that it is gradually excreted out of the body on

its own after three months. The article touches upon one study that was done and the results:

Results at three years after treatment showed a 75% reduction in the risk grade 1 rectal toxicity

complications among patients with SpaceOAR compared to those who did not receive
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SpaceOAR. Results also showed a 75% reduced risk of mild incontinence with patients that

received SpaceOAR than those who did not receive it. In addition, 78% more patients were able

to engage in sexual intercourse, had decreased bowel toxicity, less decline in both urinary and

bowel, and better quality of life with the patients who had SpaceOAR as opposed to those who

did not. The article concludes with a statement that patients should do their own research and

how physicians should openly discuss treatment options with their patients.1

This article was not useful to me as a dosimetry student and a radiation therapist. The

majority of the article was a general overview of prostate cancer, which I already knew. I believe

the author added this information into the article just to make it longer. It was not until almost to

the end that quantified information about the research study about hydrogel was presented. It was

odd to me that 75% was a number that kept being brought up such as: 75% saw reduction in

toxicity, reduced risk in incontinence, bowel toxicity, and quality of life when using SpaceOAR

as opposed to those who have not.1 This makes me question the accuracy of the study and makes

me wonder if there was a blanket statement saying 75% reduce toxicity was achieved, so that

means 75% saw bowel and incontinence toxicity decrease. I do think that there is a good chance

that some may have experienced one thing and not another. In addition, the article seem very

one-sided. There was no disadvantages of SpaceOAR mentioned.

Although I believe the article is biased and question its validity, the article could be

advantageous. The article only touches upon the surface of Hydrogel, which may be beneficial to

a patient considering treatment. It is an easy read for all levels of reading, and you don't have to

be in the medical field to understand it. It can also be used in radiation oncology to quickly read
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on what it is. The title of the article draws the audience in because who wouldn't want less

complications? So to the reader it may be an interesting topic.

Overall, the trade article was intended to help SpaceOAR gain attention from a broad

audience, including potential patients and practitioners. I do see SpaceOAR gaining attention in

the radiation therapy world, and think we will see more of it in the future. I also believe that one

day we may see hydrogel use in other anatomical parts of the body, to spare other organs at risk.

At this time, SpaceOAR is fairly new, and more clinical trials need to open up. In conclusion,

after analyzing the article, the trade journal was geared towards a broad audience and was

informal compared to a professional journal article.2

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References

1.Soffen EM. Target on Therapy: Hydrogel Reduces Prostate Cancer Treatment Complications .
Radiation Today. https://www.radiologytoday.net/archive/rt0618p30.shtml. Accessed February 6,
2019.

2. Lenards N, Weege M. Reading & Writing in Radiation Therapy & Medical Dosimetry
[SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry Program; 2018
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Analysis 2: Research Publication

To make comparing consistent, I chose the same topic for both the trade and research

article. The research article is titled, "Absorbable hydrogel spacer in men undergoing prostate

cancer radiotherapy: 12 month toxicity and proctoscopy results of a prospective multicenter

phase II trial". This is an article from the journal Radiation Oncology written by Matthias Uhl.

There was not one advertisement on this journal's website, and only scholarly articles were

presented. The articles were all divided into subsections with an abstract, introduction, methods,

results, discussion, conclusion, and references. The writing was formal as opposed to the

informal writing in the trade article. The audience changed from the trade article (broad), to peers

working in radiation oncology such as doctors, dosimetrists, and radiation therapists. The

analysis will go over the article and how the information can be used.

The article had an abstract in the beginning with a concise background, method, results,

and a conclusion. This is a brief synopsis if the reader wanted to read the main point quickly.

After the abstract, there was an introduction that discusses the incidence of prostate cancer and

how IMRT is frequently used for treatment. It does state that rectal toxicity continues to be

problematic even with IMRT, and introduces hydrogel as a means to reduce toxicity by creating a

space between the prostate and the rectum.1 To summarize the article, it was a research study to

evaluate safety, clinical, and dosimetric effects of hydrogel. The methods of the study were

reliable and clearly explained. The sample was large and represented the population of interest.

52 men were the subjects, that had T1 or T2 prostate cancer, with a prostate under 80cc, Gleason

score less than or equal to 6, or 7 with grade predominant pattern. Candidates were not selected

if they had metastasis or if any lymph nodes were to be treated with radiation. Also, no
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candidates were considered if they had prior prostate surgery, uncontrolled diabetes, prior

prostate radiation, had corticosteroid therapy, active bleeding, history of inflammatory bowel

disease, or history of rectal/gastrointestinal surgery. All hydrogel injection was consistent, using

a transperineal approach with a 18 gauge needle, using ultrasound.1 Treatment and planning were

consistent as well. The patients received 78 Gy over 8 weeks, at 2 Gy/fx, 5fx/week, IMRT

technique. Patient's PTV included CTV which included the GTV and 2/3 of the seminal vesicles,

with 5 mm or less posterior expansion. The guidelines were for the rectum V70 <25%, and for

the bladder V70 < 40%. 99% of the PTV to receive 95% of the dose, with a max dose of 107%.

Since the hydrogel produced a perirectal space of greater than or equal to 7.5 mm in 95.8% of the

patients, the rectal V70 was reduced greater than or equal to 25% in 95.7% of the patients, with a

mean reduction of 8 Gy. The toxicity results were detailed but can be summarized in the chart

given below.1

Grade GI toxicity scores (n GU toxicity scores (n

%) %)
Acute Late Acute Late
0 23 (48.0%) 45 10 (21.0%) 38
(95.7%) (80.9%)
1 19 2 (4.3%)2 20 8 (17.0%)4
(39.6%)1 (41.7%)3
2 6 (12.5%) 0 (0%) 17 1 (2.1%)
(35.4%)5
3 0 (0%) 0 (0%) 1 (2.1%) 0 (0%)
4 0 (0%) 0 (0%) 0 (0%) 0 (0%)
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Grade 1 or 25 (52.1%) 2 (4.3%) 38 (79.2%) 9 (19.1%)

worse
Grade 2 or 6 (12.5%) 0 (0%) 18 (37.5%)
worse
11 subject was Grade 1 at Baseline, 21 subject was Grade 1 at Baseline, 33 subjects were Grade 1
at Baseline, 46 subjects were Grade 1 at Baseline, 5 3 subjects were Grade 1 at Baseline, 1 subject
was Grade 2 at Baseline.

The results section was congested with a lot of numbers and the reader could get

confused for the chart was a supplement to help read the results. For instance, “A total of 45

(95.7%) patients experienced no late GI toxicity (95.7%), with 2 (4.3%) patients experiencing

late Grade 1 GI toxicity. There was no late Grade 2 or greater GI toxicity experienced in the

study. A total of 20 (41.7%), 17 (35.4%) and 1 (2.1%) patients experienced acute Grade 1, Grade

2 and Grade 3 GU toxicity, respectively (Table 1). There was no Grade 4 acute GU toxicity

experienced in the study. A total of 8 (17.0%) and 1 (2.1%) patients experienced late Grade 1 and

Grade 2 GU toxicity, respectively. There was no late Grade 3 or greater GU toxicity experienced

in the study.”1 I think anyone reading this section found the charts and other graphs beneficial.

The take away from the article is located in the discussion section of the article. "Dose

escalation improves local control in men with prostate cancer, concerns of rectal toxicity limits

implementation. Conformal techniques are helping resolve this problem, but despite

improvements in dose conformity, intra-fraction prostate motion can move the anterior rectum

into the high dose region. The reduction of the irradiated volume posterior to the prostate is not a

good solution, since most prostate cancers in the peripheral zone of the gland, occur adjacent to

the rectum. A very simple solution is to create more distance between the required volume to be
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irradiated and the anterior portion of the prostate.1 This can be achieved with hydrogel. Refer to

the picture below that was provided in the article.

Dose distribution a) pre- and b) post injection of spacer gel.

This article does a great job of concluding why hydrogel was effective for lowering

different toxicities such as acute and late GI and GU toxicities. It did not just make one statistic

like the trade article that stated "75% had lower GI and GU toxicities", which was a very blanket

statement. The validity of the study never went into question because the method used was very

detailed, and very consistent across the study. Pictures of dose distribution, charts, and graphs

were provided to help explain the results. This information was very useful in dosimetry and to

my radiation oncology peers. We have made a shift to using hydrogel more frequently but this

article describes the reason why and the differences in toxicity if it is not used.

In conclusion, it was very obvious to see the differences in both articles and to see that

the research article had more quality information to those in the field already. It also showed

more quantifiable evidence to prove their point. The trade article was very vague, summarized
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what prostate cancer was in the majority of it, and only touched on the surface of hydrogel

effects. I questioned the trade article’s validity. For the research article, it was clear that it was

not biased and that it was valid based on the legitimate methods used. After reading the research

article, I hope that hydrogel will be used more often in prostate patients so patients will have

reduced side effects.

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Reference

1. Uhl M, Herfarth K, Eble MJ, et al. Absorbable hydrogel spacer use in men undergoing prostate

cancer radiotherapy: 12 month toxicity and proctoscopy results of a prospective multicenter

phase II trial. Radiation Oncology. 2014;9(1). doi:10.1186/1748-717x-9-96.