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Noelle Deiter

February 10, 2018

DOS 711

After assessing examples of scholarly articles and trade publications, it is apparent the
two types of literature vary greatly in styles of writing. They also appeal to different types of
audiences. Scholarly articles present information through formal, scientific writing. This type of
writing typically appeals to the research and academic community. Conversely, trade publication
writing is more journalistic in style and appeals to a general audience. Trade publications may
also feature material which is trending or post advertisements for products. However, scholarly
articles tend to have an organized format. They generally have a focused interest and contain
research to help answer questions.1 Both articles in the analysis contain interesting and useful
information. However, the discrepancies between the types of literature impact the value one
places on the material. This analysis will compare and contrast the separate articles as to
highlight the strengths, weaknesses, usefulness, and accuracy of information.

Article Analysis Part 1: Trade Magazine

Summary

In the Radiology today article “Target on Therapy: Hydrogel Reduces Prostate Cancer
Complications”, Soffen2 aims to educate the reader on the benefits of the food and drug
administration (FDA) approved hydrogel spacer used for prostate irradiation. He begins by
recognizing the high prevalence of prostate cancer in men and proceeds to list various treatment
options for the disease. External beam radiation therapy is the most common and highly effective
treatment choice. However, there are many short- and long-term side effects associated with
radiation which impact quality of life. Issues such as fatigue, incontinence, and sexual
dysfunction often deter men from seeking treatment.2

The approval of the SpaceOAR by the FDA in 2015 presented a new method for reducing
radiation induced side effects. The injectable liquid gel hardens to create a one centimeter
protective barrier between the prostate and rectum. Thus, the rectum is displaced to prevent
injury. Soffen1 refers to a study from the International Journal of Radiation Oncology, Biology,
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Physics which claims the SpaceOAR reduces rectal toxicity as well as urinary incontinence side
effects by 75%. He also reports on results from a phase 3 clinical trial regarding sexual function
after 36 months. This trial claims 67% of SpaceOAR patients were able to achieve erections
whereas only 38% of men without SpaceOAR had erection success post-radiation. Considering
the implications of prostate radiation on quality of life and growing support for the hydrogel
SpaceOAR, Soffen2 advocates for continued research and dialogue on this topic.

Usefulness

I found this article intriguing after recent observation of a prostate plan with SpaceOAR.
The article seemed to provide useful information for me as well as the dosimetry community on
reduced side effects and complications associated with SpaceOAR. It also increased my
understanding of the difficult choices men face regarding treatment options for prostate cancer.
Yet, the viewpoint of the article left me questioning the accuracy of the material. The author
focuses only on the benefits of the hydrogel spacer and displays limited references.

Strengths and Weaknesses

Although the information in the article included statistics, the writing was presented in a
journalistic rather than scientific fashion. The language was easy to understand and would be
appealing to a broad audience such as the general public as well as the medical community.1 The
author demonstrates a high level of knowledge on the topic with his experience as a clinician in
the field of radiation oncology. He displays credible credentials as a medical doctor at Princeton
Radiation Oncology, a faculty member at Rutgers Medical School and University of
Pennsylvania, as well as a previous brachytherapy consultant for Deborah Heart and Lung
Center. His credibility along with mention of recent scientific journal studies gave the article
strength in regard to quality.

However, the article was a brief overview on the topic and contained only positive
remarks about the product SpaceOAR. It did not delve into specific details from scientific studies
or list any limitations. In this aspect, the article lacks scientific credibility and raises questions
about the author’s motivations. As a trade publication, Radiology Today promotes news,
products, and advertisements to populate the website. It is possible that this article features
SpaceOAR to promote the product rather than presenting an unbiased study or analysis.2
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Overall, the article presents interesting and pertinent information on a new product used
in radiation oncology. The author exhibits strong knowledge of the topic, but only references two
credible journal sources with his study statistics. The article also does not display a traditional,
organized, scientific approach. Therefore, the reader cannot make conclusions that SpaceOAR is
the best method for prostate radiation. Rather, further research and dialogue are recommended on
the topic.
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References

1. Lenards N, Weege M. Reading and Writing in Radiation Therapy & Medical Dosimetry.
[SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry Program; 2018.
2. Soffen, EM. Target on Therapy: Hydrogel Reduces Prostate Cancer Complications.
Radiology Today. 2018; 19(6), 30.
https://www.radiologytoday.net/archive/rt0618p30.shtml. Accessed February 4, 2019.
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Article Analysis Part 2: Professional Journal

In contrast to the trade magazine article, the professional journal article offers a more
organized and detailed approach to reporting research.1 It references other peer reviewed studies
and aims to report information for continued evaluation in the academic community. This
analysis will cover the prior critique topics along with methods and results used in the study.

Summary

The research article from the Medical Dosimetry journal is titled, “Rectal balloon use
limits vaginal displacement, rectal dose, and rectal toxicity in patients receiving IMRT for
postoperative gynecological malignancies”. In this article the authors Wu et al2 identify a need
for research on rectal balloon use in gynecologic radiation therapy. Although intensity modulated
radiation therapy (IMRT) techniques have significantly improved acute and chronic side effects,
there is still worry weather vaginal movement is adding to the need for larger target margins.
These margins can significantly impact toxicities for small bowel, bladder and rectum. Many
studies show effectiveness for rectal balloon use with prostate cancer, but there is not much data
for gynecologic malignancies. Wu et al2 theorize rectal balloon usage will decrease vaginal
movement uncertainties, rectal dose, and side effects for gynecologic IMRT cases.

Design and Methods Analysis

This section of the literature describes the type of study, number of patients involved,
calculations and statistics, and toxicity assessment. It also explains detailed criteria of simulation,
dose constraints, and treatment setup imaging.2 The type of study is a quantitative, non-
experimental design conducted retrospectively.3 Data was acquired from 28 patients who
received treatment between 2012 and 2015. The average age of the patients was 61.7 years.
Cancer types in the study varied from 57% with uterine, 32% with cervical, and 11% with other
gynecologic cancers such as vaginal, vulvar, or endocervical.2

All patients received gynecologic radiation treatment post-hysterectomy. For simulation,

each patient had a computed tomography (CT) contrast scan with a full bladder in addition to a
water filled rectal balloon. Prior to treatment each day, the patients were aligned with cone beam
CT (CBCT) approved by the physician. The daily vaginal cuff shift information from the
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imaging was obtained from the electronic chart to use for the study calculations. Shifts included
average displacement, absolute magnitude, and average magnitude. Also, part of the calculations
and statistics were rectal and bladder constraints. These numbers were assessed following
Radiation Therapy Oncology Group (RTOG) 0418 and RTOG 1203 guidelines for IMRT
postoperative pelvis. Finally, toxicity was reported and divided into acute and late categories by
RTOG criteria.2

Results & Discussion

After review of 663 CBCT images, shift measurements showed use of the rectal balloon
decreased anterior/posterior vaginal displacement. Average displacement was 0.4 mm superior,
0.23 mm left, and 0.16 mm anterior. When compared to previous studies with no bladder or
rectal instructions, the overall shifts were equal or smaller. Dose to the rectum and bladder was
also quite low with a mean rectal V40 dose at 39.3%. This is more than 2 standard deviations
below the RTOG constraint. However, the achieved V30 was 65% which is over the RTOG goal
constraint. Wu et al2 declares this number is within 1 standard deviation and might be achievable
with further planning. Regardless of the V30 constraint, the reported acute and late genitourinary
toxicities were all less than grade 3 status.

The study data supports the rectal balloon strategy with low toxicity numbers and equal
or less vaginal displacement. It identifies constraints to be achievable although the V30
constraint was not met. In addition to IMRT techniques and full bladder instructions, Wu et al2
concludes the rectal balloon will ensure optimal target coverage and less side effects for patients.

My overall impression of the study was that it was very valuable information for those in
the field of radiation therapy and medical dosimetry. Wu et al2 lists other studies which confirm
vaginal movement can be significant to gynecologic treatments. This raises concern as to the
accuracy of treatment, especially with more conformal IMRT plans. This study is one very few
which assesses the effectiveness of rectal balloons for post-hysterectomy IMRT cases. I think
this indicates the need for further research on the topic.

The comparison of the two articles makes it quite apparent how similar information can
be presented in vastly different ways. Both articles offer useful facts on the reduction of
toxicities and side effects. However, the article by Wu et al2 was more statistically detailed and
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proposed an answer to a clinical question. Conversely, the trade article was a brief overview and
reported only favorable facts from limited sources.
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References

1. Lenards N, Weege M. Reading and Writing in Radiation Therapy & Medical Dosimetry.
[SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry Program; 2018.
2. Wu CC, Wuu YR, Yanagihara T, et al. Rectal balloon use limits vaginal displacement,
rectal dose, and rectal toxicity in patients receiving IMRT for postoperative
gynecological malignancies. Medical Dosimetry. 2017; 43:23-29. DOI:
10.1016/j.meddos.2017.07.011
3. Lenards N. Research Design. [SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry
Program; 2016.