Open Access Research

Feasibility and radiation induced toxicity regarding the first application of transperineal implementation of biocompatible balloon for high dose radiotherapy in patients with prostate carcinoma

Vassilis Kouloulias125*, Theodoros Kalogeropoulos3, Kalliopi Platoni1, John Georgakopoulos1, George Matsopoulos2, Dimitris Chaldeopoulos1, Ivelina Beli1, Panagiotis Pantelakos1, Charalambos Asimakopoulos1, John Kouvaris4 and Nikolaos Kelekis1

Author Affiliations

1 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University hospital, Xaidari, Greece

2 Institute of Communication and Computer Science, Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece

3 Urology Department, St. Sawwas Anticancer Hospital, Athens, Greece

4 1st Department of Radiology, Radiotherapy Unit, Aretaieion University, Athens, Greece

5 Radiation Oncology, Medical School, National University of Athens, Rimini 1, ATTIKON University Hospital, Xaidari, 12462, Greece

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Radiation Oncology 2013, 8:82  doi:10.1186/1748-717X-8-82

Published: 8 April 2013



To evaluate the feasibility of the transperineal implementation of biocompatible balloon (Prospace) and the acute toxicity of high dose 3DCRT in patients with localized low risk prostate cancer.

Materials and methods

Between December 2011 and April 2012, fifteen patients were treated with external 3DCRT consisted of 76–78 Gy in 38–39 daily fractions (2.0 Gy/ fraction). Before 3DCRT, we placed the Prospace though the perineum by a minimally invasive procedure in the intermediate space between the rectum and the prostate. The primary study endpoint was the evaluation of acute toxicity according to the EORTC/RTOG radiation toxicity scale. Erectile function was evaluated with the IIEF-5 questionnaire. Rectosigmoidoscopy was performed at baseline, at the end of 3DCRT and 3 months thereafter in order to assess also the rectal toxicity according to Subjective-RectoSigmoid (S-RS) scale. The evaluation of pain related to Prospace implementation was done with the visual analogue score (VAS).


The acute toxicities were as follows: grade I GI toxicity in two patients and for GU toxicity, three patients with grade I of nocturia, four patients with grade I of frequency, two patients with grade I and two patients with grade II of dysouria. The mean score of rectal toxicity according to S-RS score was 1.8(±0.6). The mean VAS score related to Prospace was 1.4(±0.5). Erectile function was unchanged. The Prospace device was found stable in sequential CTs during irradiation.


The implementation of PROSPACE was feasible, while the acute radiation toxicity was low and comparable with IMRT techniques.

Acute toxicity; Biocompatible balloon; Prostate cancer; Radiotherapy