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In this study, employing 5-fraction stereotactic ablative radiotherapy (SABR) volumetric modulated arc therapy (VMAT) to deliver 40\u00a0Gy to the prostate clinical target volume (CTV) while boosting the DIL up to 50\u00a0Gy was evaluated for patients before and after rectal spacer insertion.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>24 Computed Tomography (CT) scans of 12 prostate cancer patients with unfavourable intermediate or high risk prostate cancer were employed in this study. At least two treatment plans were generated for each patient to compare pre- and post-spacer insertion plans. Plans were evaluated for target coverage, organs-at-risk doses, and the achievable boost dose level.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The CTV coverage was significantly better in plans with a spacer, V<jats:sub>40Gy<\/jats:sub> 98.4% versus 97.0% (p\u2009=\u20090.012). Using spacers significantly reduced rectal dose in all 12 patients in this study. It was possible to boost DIL to 50\u00a0Gy to without violating dose constraints in 6 of 12 patients and to 47.5\u00a0Gy in 3 patients post-spacer insertion. For 3 patients (25%) it was not possible to boost DIL above 45\u00a0Gy even with a spacer in situ. Without a spacer, for 6 patient (50%) clinically acceptable plan were only achieved when the DIL dose was lowered to 45\u00a0Gy. In five of these 6 patients the dose limiting structure was the urethra (urethra planning risk volume V<jats:sub>45Gy<\/jats:sub> [cc]\u2009\u2264\u20090.1\u00a0cc constraint).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Clinically acceptable plans for 5 fraction SABR, 40\u00a0Gy to the prostate CTV, with a SIB to DIL (45\u201350\u00a0Gy) were achieved. The boost dose achieved was DIL location dependent and primarily affected by DIL\u2019s proximity to the urethra. Compared to plans before spacer insertion, higher DIL dose were achieved with spacer in situ for 25% of the patients. Moreover, significant reduction in rectal dose and better target coverage were also achieved for all patients with spacers in situ.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13014-022-02003-8","type":"journal-article","created":{"date-parts":[[2022,2,22]],"date-time":"2022-02-22T12:03:52Z","timestamp":1645531432000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Simultaneous integrated boost (SIB) to dominant intra-prostatic lesions during extreme hypofractionation for prostate cancer: the impact of rectal spacers"],"prefix":"10.1186","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6103-5870","authenticated-orcid":false,"given":"Sarah O. 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