Implants and biodegradable tissue markers
Implantable materials may be used in an iatrogenic site. Applications include radioopaque materials for fiducial marking.
1. A method for radiation therapy comprising
introducing a hydrogel spacer at a site between a first tissue location and a second tissue location to increase a distance between the first tissue location and the second tissue location, with site being chosen to decrease radiation at the first tissue when the second tissue receives a dose of therapeutic radiation,
wherein introducing the hydrogel spacer comprises placing one or more flowable synthetic precursors at the site that comprise functional groups that undergo a covalent crosslinking reaction to make, at the site, a covalently-crosslinked biodegradable hydrogel implant that has a covalently attached radiopaque agent that comprises iodine,
with the one or more flowable synthetic precursors comprising
a water soluble branched polyethylene glycol (PEG) with at least four arms wherein between 25% and 90% of the arms each comprise the radioopaque agent linked to the arm via a nonbiodegradable linkage and the remaining arms each comprise an electrophilic functional group linked to the arm by a hydrolytically labile linkage.
2. The method of claim 1 wherein the spacer provides a fiducial marker for administration of the therapeutic radiation.
3. The method of claim 2 further comprising visualizing the interface of the fiducial marker and the second tissue.
4. The method of claim 3 wherein the visualization comprises CT, MRI, or X-ray.
5. The method of claim 1 further comprising making a radiation plan based on a visualization of the hydrogel spacer, with the hydrogel spacer being in contact with the second tissue.
6. The method of claim 5 , with the plan having a reduced uncertainty in target definition relative to a radiation plan made without the hydrogel spacer.
7. The system of claim 1 wherein degradation products of the hydrogel spacer comprise a polyethylene glycol covalently bound to the radioopaque agent, with the radioopaque agent comprising iodine.
8. The method of claim 1 wherein the hydrogel spacer has a Hounsfield number of more than about 50.
9. The method of claim 1 wherein the hydrogel spacer, as placed in the tissue, has a volume between 1 and 40 ml.
10. The method of claim 1 wherein the hydrogel spacer is stable, having dimensions that do not appreciably change following implantation for a predetermined amount of time, and thereafter softens and biodegrades.
11. The method of claim 10 wherein the predetermined amount of time is between 30 and 90 days.
12. The method of claim 1 , with the hydrogel spacer being biodegradable to produce only degradation products that are absorbed into the circulatory system and cleared from the body via renal filtration.
13. The method of claim 1 wherein the hydrogel spacer is a product of a covalent crosslinking chemical reaction between two precursors, with one of the precursors comprising the branched polyethylene glycol with at least four arms.
14. The method of claim 1 wherein the branched polyethylene glycol has a number average molecular weight from 10,000 to 100,000 Daltons.
15. The method of claim 1 wherein the hydrogel spacer is made from precursors that have no more than three contiguous amino acids.
16. The method of claim 1 further comprising visualizing margins of the hydrogel spacer with a machine selected from the group consisting of magnetic resonance imaging, X-ray, and computerized tomography.
17. The method of claim 1 further comprising passing the one or more flowable synthetic precursors in aqueous medium through a needle of 27 gauge or a smaller diameter.
18. The method of claim 1 wherein the hydrogel spacer is completely biodegradable at a time between about 30 and about 365 days.
19. The method of claim 1 further comprising a therapeutic agent in the hydrogel spacer.
20. The method of claim 1 further comprising a radiation source in the hydrogel spacer.
21. The method of claim 1 , with the radiopaque agent being present in the hydrogel spacer at a concentration of at least about 0.1% w/w.
22. The method of claim 13 wherein the second precursor consists essentially of an oligopeptide of no more than five residues, with the oligopeptide having a plurality of functional groups that are amines and/or thiols.
23. The method of claim 1 wherein the electrophilic groups are succinimidyl glutarate, succinimidyl succinate, succinimidyl carbonate, or succinimidyl adipate.