Emptying the rectum before treatment delivery limits the variations of rectal dose–volume parameters during 3DCRT of prostate cancer

Stasi, M.; Muñoz, Fernándo; Fiorino, Claudio; Pasquino, Massimo; Baiotto, Barbara; Marini, Piergiorgio; Malinverni, Giuseppe; Valdagni, Riccardo; Gabriele, P.

doi:10.1016/j.radonc.2006.08.007

Cited by 75 publications

(60 citation statements)

References 41 publications

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“…A consideration for prostate EBRT in this study is rectum motion and variable rectum contents confounding the accuracy of rectum dose distributions obtained from single static planning CTs [52,56,57]. A variety of methods have been used to estimate the impact of interfraction motion on rectum dose parameters and doseresponse modelling for prostate EBRT [8,52,[58][59][60][61].…”

Section: Inter-fraction Motion Should Be Consideredmentioning

confidence: 99%

Prostate external beam radiotherapy combined with high-dose-rate brachytherapy: dose-volume parameters from deformably-registered plans correlate with late gastrointestinal complications

et al. 2016

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Background: Derivation of dose-volume correlated with toxicity for multi-modal treatments can be difficult due to the perceived need for voxel-by-voxel dose accumulation. With data available for a single-institution cohort with long follow-up, an investigation was undertaken into rectal dose-volume effects for gastrointestinal toxicities after deformably-registering each phase of a combined external beam radiotherapy (EBRT)/high-dose-rate (HDR) brachytherapy prostate treatment.

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Section: Inter-fraction Motion Should Be Consideredmentioning

confidence: 99%

Prostate external beam radiotherapy combined with high-dose-rate brachytherapy: dose-volume parameters from deformably-registered plans correlate with late gastrointestinal complications

et al. 2016

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“…The main displacement occurred in the anterior wall [33,38,40]. Also the superior half of the rectum exhibited larger variations than the inferior one [40]. In many studies the rectal volume was found to decrease with time during the course of the treatment [42Á44].…”

Section: Set-up Error and Organ Motionmentioning

confidence: 99%

IGRT in rectal cancer

Ippolito

Mertens²,

Haustermans³

et al. 2008

Acta Oncologica

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“…Despite use of image guidance, rectal distension can significantly influence rectal doses and consequent toxicities 8,25,29 and potentially impact on intrafractional prostate motion, especially for hypofractionated protocols with prolonged treatment times. Rectal distension may also result in additional radiation exposure from extra CBCTs performed if the patient is required to empty their bowels after having an overfilled rectum at initial set-up.…”

Section: Discussionmentioning

confidence: 99%

Image-guided radiotherapy of the prostate using daily CBCT: the feasibility and likely benefit of implementing a margin reduction

Maund¹,

Benson²,

Fairfoul³

et al. 2014

The British Journal of Radiology

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Objective: To investigate whether planning target volume (PTV) margins may be safely reduced in radiotherapy of localized prostate cancer incorporating daily online tube potential-cone beam CT (CBCT) image guidance and the anticipated benefit in predicted rectal toxicity. Methods: The prostate-only clinical target volume (CTV2) and rectum were delineated on 1 pre-treatment CBCT each week in 18 randomly selected patients. By transposing these contours onto the original plan, dose–volume histograms (DVHs) for CTV2 and the rectum were each calculated and combined, for each patient, to produce a single mean DVH representative of the dose delivered over the treatment course. Plans were reoptimized using reduced CTV2 to PTV2 margins and the consequent radiobiological impact modelled by the tumour control probability (TCP) and normal tissue complication probability (NTCP) of the rectum. Results: All CBCT images were deemed of sufficient quality to identify the CTV and rectum. No loss of TCP was observed when plans using the standard 5-mm CTV2 to PTV2 margin of the centre were reoptimized with a 4- or 3-mm margin. Margin reduction was associated with a significant decrease in rectal NTCP (5–4 mm; p < 0.05 and 5–3 mm; p < 0.01). Conclusion: Using daily online image guidance with CBCT, a reduction in CTV2 to PTV2 margins to 3 mm is achievable without compromising tumour control. The consequent sparing of surrounding normal tissues is associated with reduced anticipated rectal toxicity. Advances in knowledge: Margin reduction is feasible and potentially beneficial. Centres with image-guided radiotherapy capability should consider assessing whether margin reduction is possible within their institutes.

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Emptying the rectum before treatment delivery limits the variations of rectal dose–volume parameters during 3DCRT of prostate cancer

Cited by 75 publications

References 41 publications

Prostate external beam radiotherapy combined with high-dose-rate brachytherapy: dose-volume parameters from deformably-registered plans correlate with late gastrointestinal complications

Prostate external beam radiotherapy combined with high-dose-rate brachytherapy: dose-volume parameters from deformably-registered plans correlate with late gastrointestinal complications

IGRT in rectal cancer

Image-guided radiotherapy of the prostate using daily CBCT: the feasibility and likely benefit of implementing a margin reduction

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