Effect of rectal enema on intrafraction prostate movement during image‐guided radiotherapy

Choi, Youngmin; Kwak, Dong-Won; Lee, Hyung-Sik; Hur, Won-Jooh; Cho, Won Yeol; Sung, Gyung Tak; Kim, Tae-Hyo; Kim, Soo Dong; Yun, Sung-Hyo

doi:10.1111/1754-9485.12239

Cited by 8 publications

(4 citation statements)

References 30 publications

(60 reference statements)

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“…However, use of enemas before daily treatment, especially with longer RT courses, is likely to be limited due to the invasive nature of their use. 25 , 45 , 46 The prescription of bowel routines in the current survey was reported by approximately 35% to 95% of respondents, varying over a broad range depending on fractionation regimen. In this study, respondents reported more frequent use of bowel instructions and preparations for delivery of SBRT relative to CFx and MHFx.…”

Section: Discussionmentioning

confidence: 82%

“…One intervention that has shown benefit in reducing rectal size and improving OAR dosimetry in multiple clinical trials is the use of enemas. However, use of enemas prior to daily treatment, especially with longer RT courses, is likely to be limited due to the invasive nature of their use [25], [45], [46]. The prescription of bowel routines in the current survey was reported by approximately 35-95% of respondents, varying over a broad range depending on fractionation regimen.…”

Section: Discussionmentioning

confidence: 87%

See 1 more Smart Citation

Bowel and Bladder Reproducibility in Image Guided Radiation Therapy for Prostate Cancer: Results of a Patterns of Practice Survey

Rowe

Mandia

Salerno

et al. 2022

Advances in Radiation Oncology

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 87%

Bowel and Bladder Reproducibility in Image Guided Radiation Therapy for Prostate Cancer: Results of a Patterns of Practice Survey

Rowe

Mandia

Salerno

et al. 2022

Advances in Radiation Oncology

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“…In our study, we noticed that, for most of the fractions, the intrafractional prostate motion was mostly smaller than 2 mm, for a period of 2 to 2.5 min. Comparably, Choi et al [ 28 ], using transrectal ultrasound scans to track three implanted fiducial markers (12 patients and 336 fractions), observed that only 11 % of the 3D vector displacements were larger than 2 mm during 4–5 min of monitoring (Table 2 ). Similarly, Li et al [ 4 ], utilizing a Calypso tracking system (35 patients and 1267 fractions), reported that the intrafractional motion of the prostate is mostly less than 2 mm, especially for the first three minutes of tracking.…”

Section: Discussionmentioning

confidence: 85%

Determining intrafractional prostate motion using four dimensional ultrasound system

Baker

Behrens

2016

BMC Cancer

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BackgroundIn prostate radiotherapy, it is essential that the prostate position is within the planned volume during the treatment delivery. The aim of this study is to investigate whether intrafractional motion of the prostate is of clinical consequence, using a novel 4D autoscan ultrasound probe.MethodsTen prostate patients were ultrasound (US) scanned at the time of CT imaging and once a week during their course of radiotherapy treatment in an ethics-approved study, using the transperineal Clarity autoscan system (Clarity®, Elekta Inc., Stockholm, Sweden). At each US scanning session (fraction) the prostate was monitored for 2 to 2.5 min, a typical beam-on time to deliver a RapidArc® radiotherapy fraction. The patients were instructed to remain motionless in supine position throughout the US scans. They were also requested to comply with a bladder-filling protocol. In total, 51 monitoring curves were acquired. Data of the prostate motion in three orthogonal directions were analyzed. Finally, the BMI value was calculated to investigate correlation between BMI and the extent of prostate displacement.ResultsThe patients were cooperative, despite extra time for applying the TPUS scan. The mean (±1SD) of the maximal intrafractional displacements were [mm]; I(+)/S: (0.2 ± 0.9); L(+)/R: (−0.2 ± 0.8); and A(+)/P: (−0.2 ± 1.1), respectively. The largest displacement was 2.8 mm in the posterior direction. The percentage of fractions with displacements larger than 2.0 mm was 4 %, 2 %, and 10 % in the IS, LR, and AP directions, respectively. The mean of the maximal intrafractional Euclidean distance (3D vector) was 0.9 ± 0.6 mm. For 12 % of the fractions the maximal 3D vector displacements were larger than 2.0 mm. At only two fractions (4 %) displacements larger than 3.0 mm were observed. There was no correlation between BMI and the extent of the prostate displacement.ConclusionsThe prostate intrafractional displacement is of no clinically consequence for treatment times in the order of 2 – 2.5 min, which is typical for a RapidArc radiotherapy fraction. However, prostate motion should be considered for longer treatment times eg if applying conventional or IMRT radiotherapy.

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“…Different approaches have been proposed to reduce prostate motion by reducing the extent and the variability of rectal volume or the amount of rectal gas during RT, including mechanical approaches like the daily application of endorectal balloons or daily enema. While the effectiveness of the endorectal balloon remains unclear, the use of daily enema seems to have a positive impact on both intraand interfractional motion [12][13][14]. Thus, in some radiooncology centers it is part of the clinical routine [15].…”

Section: Introductionmentioning

confidence: 99%

Impact of a low FODMAP diet on the amount of rectal gas and rectal volume during radiotherapy in patients with prostate cancer – a prospective pilot study

et al. 2020

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Background: Small inter-and intrafractional prostate motion was shown to be a prerequisite for precise radiotherapy (RT) of prostate cancer (PCa) to achieve good local control and low rectal toxicity. As rectal gas and rectal volume are known to have a relevant effect on prostate motion, this study aims to reduce these parameters by using a Low FODMAP Diet (LFD) and to show feasibility of this intervention. Methods: We compared a prospective intervention group (IG, n = 25) which underwent RT for PCa and whose patients were asked to follow a LFD during RT with a retrospective control group (CG, n = 25) which did not get any dietary advice. In the planning CT scan and all available cone beam CT scans rectal gas was classified based on a semiquantitative score (scale from 1 to 5) and rectal volume was measured. Furthermore, patients' compliance was evaluated by a self-assessment questionnaire. Results: Clinical and treatment characteristics were well balanced between both groups. A total of 266 (CG, 10.6 per patient) and 280 CT scans (IG, 11.2 per patient), respectively, were analysed. The frequency distribution of gas scores differed significantly from each other (p < .001) with the IG having lower scores. Rectal volume was smaller in the IG (64.28 cm 3 , 95% CI 60.92-67.65 cm 3 , SD 28.64 cm 3) than in the CG (71.40 cm 3 , 95% CI 66.47-76.32 cm 3 , SD 40.80 cm 3) (p = .02). Mean intrapatient standard deviation as a measure for the variability of rectal volume was 22 cm 3 in the IG and 23 cm 3 in the CG (p = .81). Patients' compliance and contentment were satisfying. Conclusions: The use of a LFD significantly decreased rectal gas and rectal volume. LFD was feasible with an excellent patients' compliance. However, prospective trials with a larger number of patients and a standardized evaluation of gastrointestinal toxicity and quality of life are reasonable. Trial registration: German Clinical Trials Register, DRKS00012955.

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Effect of rectal enema on intrafraction prostate movement during image‐guided radiotherapy

Abstract: A daily rectal enema before each RT fraction was tolerable and yielded little intrafraction prostate displacement. We think the use of rectal enemas is a feasible method to reduce prostate movement during RT.

Cited by 8 publications

References 30 publications

Bowel and Bladder Reproducibility in Image Guided Radiation Therapy for Prostate Cancer: Results of a Patterns of Practice Survey

Bowel and Bladder Reproducibility in Image Guided Radiation Therapy for Prostate Cancer: Results of a Patterns of Practice Survey

Determining intrafractional prostate motion using four dimensional ultrasound system

Impact of a low FODMAP diet on the amount of rectal gas and rectal volume during radiotherapy in patients with prostate cancer – a prospective pilot study

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