{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T20:08:01Z","timestamp":1774642081305,"version":"3.50.1"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>In recurrent gynecologic malignancies following prior pelvic irradiation, definitive radiation therapy is often precluded by cumulative dose constraints to adjacent organs at risk (OARs), and patients may be left with only highly invasive surgical options such as total pelvic exenteration. While some institutions have explored displacement techniques such as artificial ascites or hyaluronic acid gel injection, these approaches are not widely adopted and frequently fail to ensure consistent and stable separation of OARs. We report the first clinical use of Neskeep\u00ae, a bioabsorbable polyglycolic acid (PGA) spacer, in high-dose-rate (HDR) brachytherapy for recurrent cervical cancer after prior pelvic radiation. A woman in her 40s with prior hysterectomy and HDR brachytherapy for cervical intraepithelial neoplasia grade III developed vaginal stump recurrence 4\u00a0years later. Laparoscopic placement of the PGA spacer was performed to achieve durable displacement of the small bowel, followed by eight fractions of HDR brachytherapy. Hyaluronic acid gel was also injected during each fraction to displace the bladder and rectum. The spacer maintained position and volume throughout treatment without complications. Dose\u2013volume analysis showed a marked reduction in small bowel D\u2082cc (mean equivalent dose in 2 Gy fractions (EQD\u2082): 121.6\u00a0cGy) compared to the initial treatment (606.0\u00a0cGy), while the spacer itself received a mean D\u2082cc of 690.3\u00a0cGy. MRI confirmed complete response at 2\u00a0months, with no adverse events observed at that time point. The PGA spacer enabled safe, curative reirradiation in a case that would otherwise be unsuitable for further radiation therapy.<\/jats:p>","DOI":"10.1093\/jrr\/rraf053","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T10:06:40Z","timestamp":1755857200000},"page":"570-577","source":"Crossref","is-referenced-by-count":1,"title":["Technical report on the first clinical use of a bioabsorbable PGA spacer in HDR brachytherapy for recurrent cervical cancer"],"prefix":"10.1093","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8928-5433","authenticated-orcid":false,"given":"Kae","family":"Okuma","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, National Cancer Center Hospital , 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomomichi","family":"Kiyomatsu","sequence":"additional","affiliation":[{"name":"Department of Surgery, National Center for Global Health and Medicine , 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirotoshi","family":"Takiyama","sequence":"additional","affiliation":[{"name":"Radiation Oncology, QST Hospital, National Institutes for Quantum and Radiological Science and Technology , 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8655 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akane","family":"Yoshiba","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, National Cancer Center Hospital , 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6712-2294","authenticated-orcid":false,"given":"Koji","family":"Inaba","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, National Cancer Center Hospital , 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2471-605X","authenticated-orcid":false,"given":"Tairo","family":"Kashihara","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, National Cancer Center Hospital , 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5648-1884","authenticated-orcid":false,"given":"Kana","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, National Cancer Center Hospital , 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madoka","family":"Sakuramachi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, National Cancer Center Hospital , 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayaka","family":"Nagao","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, National Cancer Center Hospital , 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7817-624X","authenticated-orcid":false,"given":"Hiroshi","family":"Igaki","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, National Cancer Center Hospital , 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"2025092423163896800_ref1","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.ygyno.2012.04.036","article-title":"Phase II study of concurrent chemoradiotherapy with high-dose-rate intracavitary brachytherapy in patients with locally advanced uterine cervical cancer: efficacy and toxicity of a low cumulative radiation dose schedule","volume":"126","author":"Toita","year":"2012","journal-title":"Gynecol Oncol"},{"key":"2025092423163896800_ref2","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1016\/S1470-2045(20)30753-1","article-title":"MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study","volume":"22","author":"P\u00f6tter","year":"2021","journal-title":"Lancet Oncol"},{"key":"2025092423163896800_ref3","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.ygyno.2013.10.018","article-title":"HDR brachytherapy for the reirradiation of cervical and vaginal cancer: analysis of efficacy and dosage delivered to organs at risk","volume":"132","author":"Zolciak-Siwinska","year":"2014","journal-title":"Gynecol Oncol"},{"key":"2025092423163896800_ref4","doi-asserted-by":"publisher","first-page":"110269","DOI":"10.1016\/j.radonc.2024.110269","article-title":"Reirradiation for recurrent gynecologic cancer using high-dose-rate brachytherapy in Japan: a multicenter survey on practice patterns and outcomes","volume":"195","author":"Isohashi","year":"2024","journal-title":"Radiother Oncol"},{"key":"2025092423163896800_ref5","doi-asserted-by":"publisher","first-page":"879003","DOI":"10.3389\/fonc.2022.879003","article-title":"Image-guided interstitial brachytherapy for recurrent cervical cancer after radiotherapy: a single institution experience","volume":"12","author":"Ren","year":"2022","journal-title":"Front Oncol"},{"key":"2025092423163896800_ref6","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1016\/j.brachy.2017.11.011","article-title":"Image-guided interstitial high-dose-rate brachytherapy for locally recurrent uterine cervical cancer: a single-institution study","volume":"17","author":"Umezawa","year":"2018","journal-title":"Brachytherapy"},{"key":"2025092423163896800_ref12","first-page":"20180067","article-title":"Artificial ascites for organs at risk sparing in intrapelvic brachytherapy: a case report of recurrent uterine cervical carcinoma adjacent to the bowel","volume":"5","author":"Murakami","year":"2018","journal-title":"BJR Case Rep"},{"key":"2025092423163896800_ref13","doi-asserted-by":"publisher","first-page":"487","DOI":"10.5114\/jcb.2020.100382","article-title":"Transvaginal artificial ascites infusion as a spacer in gynecological brachytherapy: a novel technique","volume":"12","author":"Karube","year":"2020","journal-title":"J Contemp Brachytherapy"},{"key":"2025092423163896800_ref14","doi-asserted-by":"publisher","first-page":"100918","DOI":"10.1016\/j.adro.2022.100918","article-title":"Effect of hyaluronate acid injection on dose-volume parameters in brachytherapy for cervical cancer","volume":"7","author":"Kobayashi","year":"2022","journal-title":"Adv Radiat Oncol"},{"key":"2025092423163896800_ref7","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1097\/XCS.0000000000000873","article-title":"Innovative combination treatment to expand the indications of particle therapy: spacer placement surgery using bioabsorbable polyglycolic acid spacer","volume":"238","author":"Komatsu","year":"2024","journal-title":"J Am Coll Surg"},{"key":"2025092423163896800_ref8","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1111\/codi.16882","article-title":"Laparoscopic polyglycolic acid spacer placement for locally recurrent rectal cancer","volume":"26","author":"Kobayashi","year":"2024","journal-title":"Color Dis"},{"key":"2025092423163896800_ref9","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1093\/jrr\/rraa087","article-title":"Impact on dose distribution and volume changes of a bioabsorbable polyglycolic acid spacer during chemo-proton 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