Rectum and Bladder Dose Variations During Prostate IGRT: An Evaluation of Bowel and Bladder Preparation Protocol

Jotwani, Anjali R.; Surendran, J.; Chilukuri, Srinivas; Ramamohan, R.; Ibrahim, Safiyo; Shivakumar, R.

doi:10.1016/j.ijrobp.2012.07.1042

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“…Although patients in our study were instructed to follow a high-fibre diet throughout the course of their treatment in order to achieve a consistency of bowel transit and volume, others have concluded that a high-fibre diet does not improve the consistency of rectal filling. [26][27][28] The use of daily CBCT to visualise the extent of rectal filling, as well as PTV position, has been Effect of BMI or SAT on interfraction prostate motion employed as an IGRT method in some departments and it would certainly be interesting to use CBCT to examine whether there is a correlation between patient size and the extent of variation in rectal volume between fractions.…”

Section: Discussionmentioning

confidence: 99%

Does body mass index or subcutaneous adipose tissue thickness affect interfraction prostate motion in patients receiving radical prostate radiotherapy?

2016

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AimIt is unclear whether body mass index (BMI) is a useful measurement for examining prostate motion. Patient’s subcutaneous adipose tissue thickness (SAT) and weight has been shown to correlate with prostate shifts in the left/right direction. We sought to analyse the relationship between BMI and interfraction prostate movement in order to determine planning target volume (PTV) margins based on patient BMI.Materials and methodsIn all, 38 prostate cancer patients with three implanted gold fiducial markers in their prostate were recruited. Height, mass and SAT were measured, and the extent of interfraction prostate movement in the left/right, superior/inferior and anterior/posterior directions was recorded during each daily fiducial marker-based image-guided radiotherapy treatment. Mean corrective shift in each direction for each patient, along with BMI values, were calculated.ResultsThe median BMI value was 28·4 kg/m2 (range 21·4–44·7). Pearson’s product-moment correlation analysis showed no significant relationship between BMI, mass or SAT and the extent of prostate movement in any direction. Linear regression analysis also showed no relationship between any of the patient variables and the extent of prostate movement in any direction (BMI: R2=0·006 (ρ=0·65), 0·002 (ρ=0·80) and 0·001 (ρ=0·86); mass: R2=0·001 (ρ=0·87), 0·010 (ρ=0·54) and 0·000 (ρ=0·99); SAT: R2=0·012 (ρ=0·51), 0·013 (ρ=0·50) and 0·047 (ρ=0·19) for shifts in the X, Y and Z axis, respectively). Patients were grouped according to BMI, as BMI<30 (n=25, 65·8%) and BMI≥30 (n=13, 34·2%). A two-tailed t-test showed no significant difference between the mean prostate shifts for the two groups in any direction (ρ=0·320, 0·839 and 0·325 for shifts in the X, Y and Z axis, respectively).FindingsBMI is not a useful parameter for determining individualised PTV margins. Gold fiducial marker insertion should be used as standard to improve treatment accuracy.

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Section: Discussionmentioning

confidence: 99%