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Moving Radiation Therapy for Prostate Cancer to the Next Level with HDR Brachytherapy and SpaceOAR®

Shariq KhwajaA unique collaboration between radiation oncology and urology at Memorial Hermann Cancer Center-Memorial City has raised the standard of care for prostate cancer patients, improved patient satisfaction and increased volumes. One of only a few centers in the Greater Houston area offering high-dose rate (HDR) brachytherapy for prostate cancer, it is also the only center with a radiation oncologist, Shariq Khwaja, M.D., Ph.D., certified by Augmenix® to use SpaceOAR, an abbreviation for Spacing Organs at Risk, which offers rectal protection for prostate cancer radiation therapy patients.

“By collaboration, I mean that the radiation oncologist and the urologist are both in the OR at the same time, when usually it’s just the radiation oncologist doing the procedure alone,” says Dr. Khwaja, who practices primarily at Memorial Hermann Memorial City Medical Center. “Patient safety and patient satisfaction are our main goals. By working closely together we can present our patients with the best option for treatment.”

Dr. Khwaja collaborates with urologists Andrew Selzman, M.D.; Paul Smith, M.D.; and Ramesh Krishnan, M.D., who are affiliated with Memorial Hermann Medical Group Urology Memorial City. Prostate cancer patients who have low risk or favorable intermediate risk are offered HDR brachytherapy as an alternative monotherapy to surgery or external beam radiation therapy.

“HDR brachytherapy treats prostate tumors with very high doses of localized radiation that greatly reduce the dose to surrounding healthy tissues,” he says. “Using ultrasound guidance, we place tiny, hollow catheters in the prostate and then insert a radioactive wire into each of the catheters. Treatment is accomplished in two implants spaced two weeks apart versus the usual eight to nine weeks of daily treatment with external beam radiation therapy.

HDR brachytherapy is a good option for patients who are not candidates for a radical prostatectomy or who may not be able to come in for eight weeks of radiation therapy. Offering it has allowed us to attract patients from greater distances.”

For prostate cancer patients who are not candidates for HDR brachytherapy or surgery, Dr. Khwaja uses SpaceOAR hydrogel as an alternative to inserting a temporary balloon to protect the rectum during external beam radiation therapy. Placed between the prostate and rectum, the one-time temporary implant pushes the rectum out of the region of high-dose radiation. The hydrogel spacer is injected during a minimally invasive procedure. It remains in place for three to six months during radiation treatment and then is absorbed by the body.

Healthy cells in the rectum can be damaged during radiation therapy. SpaceOAR, has been proven to minimize the rectal side effects of external beam radiation and improve quality of life for prostate cancer patients undergoing radiation therapy.

“I offer the hydrogel to all my patients, and all have tolerated the 30-minute procedure well,” says Dr. Khwaja, who is certified to perform this procedure and has now completed more than 30 cases. “As radiation oncologists we use extremely high-energy X-rays to treat cancer, and this must be done in a precise and accurate manner. From a patient satisfaction standpoint, we’re intimately involved with care, assessing any side effects on a daily to weekly basis, depending on the patient and the treatment.”