Increased risk of biochemical and local failure in patients with distended rectum on the planning CT for prostate cancer radiotherapy

Crevoisier, R. de; Tucker, Susan L.; Dong, Lei; Mohan, Radhe; Cheung, R.; Cox, James D.; Kuban, Deborah A.

doi:10.1016/j.ijrobp.2004.11.032

Cited by 365 publications

(185 citation statements)

References 43 publications

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“…We acknowledge that many authors assessed rectal filling with more complex measurements such as the mean cross-sectional area [1,6,7]. In this study, we selected two surrogate measures for rectal distension using the rectal diameter (AP and lateral) taken at a mid-point level of the treatment volume, since in studies assessing PSA relapse [1] or prostate movement [8] where multiple parameters were calculated, the rectal diameter remained significant.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, we selected two surrogate measures for rectal distension using the rectal diameter (AP and lateral) taken at a mid-point level of the treatment volume, since in studies assessing PSA relapse [1] or prostate movement [8] where multiple parameters were calculated, the rectal diameter remained significant. Furthermore, the relative ease, reproducibility and consistency of this calculation allow it to remain clinically practical.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the work carried out by De Crevoisier et al [1], Engels et al [7] recently published a small retrospective study of 50 patients, where rectal distension was negatively associated with poor biochemical control in spite of daily image-guided treatment. On the other hand, Kupelian et al [9] found no differences in biochemical control in patients with and without rectal distension in a larger retrospective series of 488 patients undergoing regular image guidance.…”

Section: Discussionmentioning

confidence: 99%

“…Both are susceptible to error from patient set-up and internal organ motion. It has been reported that significant rectal distension seen on radiotherapy planning CT scanning is a poor prognostic factor for treatment failure, presumably due to geographical misses caused by prostate gland movement [1]. Studies have also shown that a reduction in the rectal volume during treatment results in a higher propensity for geographical miss due to internal organ movement, resulting in a clinically significant underdosing to the target volume and a higher rate of treatment failure [2,3].…”

Section: Introductionmentioning

confidence: 99%

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Degree of Rectal Distension Seen on Prostate Radiotherapy Planning CT Scan Is Not a Negative Prognostic Factor in the Modern Era of Image-Guided Radiotherapy

Silverman

Johnson²,

Perry³

et al. 2015

Oncology

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Background: Studies have shown that rectal distension has a significant impact on treatment failure in patients receiving radical radiotherapy for prostate cancer. A distended rectum contributes to excessive organ movement during treatment, resulting in significant underdosing of the target volume and higher treatment failure rates. The increasing use of highly conformal, precise radiotherapy techniques places greater importance on reducing this risk. We tested whether imaging during radiotherapy helps minimise the negative impact that rectal distension has on long-term tumour control. Findings: The rectal diameter (anterior/posterior and lateral) was prospectively measured at radiotherapy planning in 172 consecutive patients undergoing radical radiotherapy with three-dimensional conformal radiotherapy. Daily, and then weekly, imaging during radiotherapy ensured that prostate movement remained within predefined tolerances. Patients were followed up for a median of 72 months with regular prostate-specific antigen (PSA) measurements to ascertain biochemical PSA relapse and survival information. Conclusions: In this cohort of predominately high-risk localised prostate cancer, rectal distension had no significant impact on PSA relapse. We suggest that regular imaging during radiotherapy negates the risk caused by rectal distension on local treatment failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Degree of Rectal Distension Seen on Prostate Radiotherapy Planning CT Scan Is Not a Negative Prognostic Factor in the Modern Era of Image-Guided Radiotherapy

Silverman

Johnson²,

Perry³

et al. 2015

Oncology

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“…[1][2][3][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Distinctive anatomical features characterized the first nine definitions of the rectum as an OAR, whereas the last four were functional definitions, in which the rectum was exclusively considered with regard to the PTV. All the contouring throughout the entire study was performed by one experienced consultant (RMH) to exclude interobserver variability.…”

Section: Methodsmentioning

confidence: 99%

Comparison of different contouring definitions of the rectum as organ at risk (OAR) and dose–volume parameters predicting rectal inflammation in radiotherapy of prostate cancer: which definition to use?

Nitsche

Brannath

Brückner

et al. 2017

The British Journal of Radiology

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MN and RMH contributed to the conception, design, analysis and interpretation of data and helped with the final approval of the version to be published. MN, RMH and NT helped with the drafting of the article. WB and MB contributed to the statistics of the main study. DW contributed to the acquisition of data. AK contributed to the statistics of pre-study. NT helped with the planning and implementation of radiotherapy.Objective: The objective of this retrospective planning study was to find a contouring definition for the rectum as an organ at risk (OAR) in curative three-dimensional external beam radiotherapy (EBRT) for prostate cancer (PCa) with a predictive correlation between the dosevolume histogram (DVH) and rectal toxicity. Methods: In a pre-study, the planning CT scans of 23 patients with PCa receiving definitive EBRT were analyzed. The rectum was contoured according to 13 different definitions, and the dose distribution was correlated with the respective rectal volumes by generating DVH curves. Three definitions were identified to represent the most distinct differences in the shapes of the DVH curves: one anatomical definition recommended by the Radiation Therapy Oncology Group (RTOG) and two functional definitions based on the target volume. In the main study, the correlation between different relative DVH parameters derived from these three contouring definitions and the occurrence of rectal toxicity during and after EBRT was studied in two consecutive collectives. The first cohort consisted of 97 patients receiving primary curative EBRT and the second cohort consisted of 66 patients treated for biochemical recurrence after prostatectomy. Rectal toxicity was investigated by clinical investigation and scored according to the Common Terminology Criteria for Adverse Events. Candidate parameters were the volume of the rectum, mean dose, maximal dose, volume receiving at least 60 Gy (V 60 ), area under the DVH curve up to 25 Gy and area under the DVH curve up to 75 Gy in dependence of each chosen rectum definition. Multivariable logistic regression considered other clinical factors such as pelvine lymphatics vs local target volume, diabetes, prior rectal surgery, anticoagulation or haemorrhoids too.

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Radiation Therapy, Quality Assurance in

Gejerman

Hanley

2006

Encyclopedia of Medical Devices and Instrumentation

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A prerequiste to a successful radiation oncology prgram is accurate treatment planning and consistent treatment delivery. The Nuclear Regulatory Commission and most state regulatory bodies have published quality assurance guidelines requiring interval testing of the simulation, treatment planning, and treatment delivery process. Recognizing the challenge of ensuring proper maintenance and use of increasingly complicated systems, the American Assiciation of Physicists (AAPM) published a series of comprehensive quality assurance guidelines that can be applied to X‐ray and CT simulators, treatment planning systems, and linear accelerators. Comprehensive quality assurance must encompass both systematic and random uncertainity in treatment planning and delivery to minimize their occurrence. The many factors that contribute to target dilineation uncertanity including acquisition parameters, organ motion, imaging modality, image fusion, and intra‐observer variablity should all be examined closely for their contributions to treatment uncertainities. To minimize treatment inaccuracies, it is essential that each radiation oncology department establishes a “quality system” or quality assurance program to provide the organizational structure, responsibilities, procedures, processes, and resources for assuring the quality of patient management.

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Increased risk of biochemical and local failure in patients with distended rectum on the planning CT for prostate cancer radiotherapy

Cited by 365 publications

References 43 publications

Degree of Rectal Distension Seen on Prostate Radiotherapy Planning CT Scan Is Not a Negative Prognostic Factor in the Modern Era of Image-Guided Radiotherapy

Degree of Rectal Distension Seen on Prostate Radiotherapy Planning CT Scan Is Not a Negative Prognostic Factor in the Modern Era of Image-Guided Radiotherapy

Comparison of different contouring definitions of the rectum as organ at risk (OAR) and dose–volume parameters predicting rectal inflammation in radiotherapy of prostate cancer: which definition to use?

Radiation Therapy, Quality Assurance in

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