The BC Cancer Excellence Awards give us an opportunity to shine a light on some of the inspiring people and teams at BC Cancer. Nominations will be accepted from June 3 to August 16, 2019. During this nomination period for the second annual BC Cancer Excellence Awards, we’re taking an occasional look at one of 2018’s winners. Go to bccancer.bc.ca/awards for more information and to submit a nomination today.
The Space OAR Hydrogel team received the inaugural Innovation and Discovery in Action award last fall. The Space OAR Hydrogel team members are Dr. Abe Alexander, Dr. Jennifer Goulart, Dr. Howard Pai, Dr. Jacqueline Lam, Isabelle M. Gagne, Cloe Vignola, Clare Sutton, Heather Dickson, Michelle Brown, Rachelle Sankey and Brigit Jensen. We spoke with BC Cancer - Victoria radiation oncologist Abe Alexander about his thoughts on the meaning of the award and his team's work:
We started a provincial program incorporating Space OAR Hydrogel in to prostate external beam radiotherapy. This product has been in use in the U.S. and Europe, but as far as I know, BC Cancer was the first centre to start a funded Space OAR Hydrogel program in Canada.
We initially presented the idea for starting the program at a prostate cancer support group meeting. As a result, the Island Prostate Centre provided funding for us to purchase some initial units of the product, which allowed us to gain experience with the product and its use.
Basically, Space OAR Hydrogel is a polyethylene glycol-based gel that is injected between the prostate and the rectum. It moves the rectum away from the prostate by about 1 to 1.5 centimetres. This significantly reduces the amount of radiation received by the rectum during prostate radiotherapy and reduces bowel side effects. In fact, use of the hydrogel has been shown in a pivotal phase 3 trial to significantly reduce long-term bowel toxicity of prostate radiotherapy and allow men to maintain their pre-treatment quality of life. It also seems to help reduce the risk of bladder and sexual dysfunction from prostate radiotherapy. It is especially important for me with conditions that put them at particularly high risk for bowel toxicity from radiotherapy (like Crohn’s disease) who are very difficult to treat with external beam radiotherapy without the hydrogel.
As I mentioned, our group started the Space OAR Hydrogel program in B.C. Putting the program together took a lot of work between radiation oncology, nursing, radiation therapists, medical physics, and the clerical booking staff. We have done approximately 25 to 30 cases in our program thus far. We now have two oncologists certified to implant the gel, so we are now embarking on more regular use. We plan to devote two days per month to Space OAR Hydrogel implants, allowing to treat six to eight patients with it each month. All the men we have treated thus far have done very well.
We have used this opportunity for research as well. Our group has already published a study exploring the optimal radiation planning techniques with Space OAR Hydrogel to minimize rectal dose, and we are currently working on an algorithm to predict, ahead of time, which patients are likely to benefit the most from the use of Space OAR Hydrogel. We are studying how useful the hydrogel is in reducing rectal dose in patients with prosthetic hips. And we have a physics graduate student who devoted his time, and thesis, to Space OAR Hydrogel research, based on data from our patient cohort.
We have analyzed radiation plans of all our Space OAR Hydrogel patients both before and after implementation of the gel to evaluate its impact. All our patients showed a significant reduction in rectal radiation dose as a result of the gel. In fact, the rectal radiation doses were at least as low, often even lower, than was seen in the pivotal phase 3 trial of the hydrogel. Also, the increase in the distance between the rectum and the prostate in our patients was comparable to that seen in the pivotal trial. Given these results, the expectation is that our patients should experience the very favourable bowel toxicity profile that was reported in the pivotal trial. Of course, we don’t yet have enough follow-up time with our hydrogel patient cohort to report their specific incidence of bowel side effects, but we plan to do so when we are able to.
Our team was comprised of radiation therapists, oncology nurses, medical physics, radiation oncologists and radiotherapy booking clerks. Having all these different disciplines on board is really what made this program work. Each team member brings different skills to the table, vital for the project. Every team member is dedicated to improving patient care, and this is reflected by their work and attitudes.
At this point we are moving to increase its use. As mentioned, we are aiming to use the gel in six to eight external beam radiotherapy patients per month. We also want to try to incorporate its use into emerging radiation techniques – specifically Stereotactic Ablative Radiotherapy (SABR). We feel the combination of Space OAR Hydrogel with prostate SABR could lead to more effective and convenient treatment for me with prostate cancer while minimizing treatment-related toxicity.
Many of the Space OAR Hydrogel team members are working on a number of other projects with each other and with other groups. Some of these other projects include work with novel radiotherapy techniques, such as SABR, artificial intelligence for radiation planning, ways to improve supportive care, as well as clinical trials.
The concept of the BC Cancer Excellence Awards is great. It is an excellent way to recognize the efforts of BC Cancer staff who try to improve patient care. It has meant a lot to our group to be selected as the winner of this award. It’s very satisfying to have our hard work recognized. But also, it’s an indication that we are putting our efforts toward endeavours that others also feel are important. And it really emphasizes to us how much more we can accomplish working together, as opposed to each of us working alone on our own isolated projects.