The implementation of an empty bladder filling protocol for localised prostate volumetric modulated arctherapy (VMAT): early results of a single institution service evaluation

Chetiyawardana, G.; Hoskin, Peter; Tsang, Y.

doi:10.1259/bjr.20200548

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…They found non-inferiority of an empty bladder filling protocol comparing to a full bladder filling protocol in respect to biological progression-free survival and GU and GI toxicities. 42 Our clinical findings in image-guided SSPT were consistent with the reports of X-ray therapy from Byun et al and Chetiyawardana et al and, therefore, a bladder-emptying protocol could be preferable by virtue of reducing BV variation. Past studies which found correlations between BV and clinical outcome is for early GU toxicity and needs to be evaluated further for late toxicities but the inclusion of patients who received irradiation or surgery of the pelvis in their series may be related to the correlation between BV and GU toxicity.…”

Section: Discussionsupporting

confidence: 90%

Are simple verbal instructions sufficient to ensure that bladder volume does not deteriorate prostate position reproducibility during spot scanning proton therapy?

et al. 2021

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Objectives: The purpose of this study is to investigate whether verbal instructions are sufficient for bladder volume (BV) control not to deteriorate prostate position reproducibility in image-guided spot scanning proton therapy (SSPT) for localized prostate cancer. Methods: A total of 268 treatment sessions in 12 consecutive prostate cancer patients who were treated with image-guided SSPT with fiducial markers were retrospectively analyzed. In addition to strict rectal volume control procedures, simple verbal instructions to void urine one hour before the treatment were used here. The BV was measured by a Bladder Scan just before the treatment, and the prostate motion was measured by intraprostatic fiducial markers and two sets of X-ray fluoroscopy images. The correlation between the BV change and prostate motion was assessed by linear mixed-effects models and systematic and random errors according to the reproducibility of the BV. Results: The mean absolute BV change during treatment was from −98.7 to 86.3 ml (median 7.1 ml). The mean absolute prostate motion of the patients in the left-right direction was −1.46 to 1.85 mm; in the cranial-caudal direction it was −6.10 to 3.65 mm, and in the anteroposterior direction −1.90 to 5.23 mm. There was no significant relationship between the BV change and prostate motion during SSPT. The early and late genitourinary and gastrointestinal toxicity was minimal with a minimum follow up of 4.57 years. Conclusions: Simple verbal instructions about urination was suggested to be sufficient to control the BV not to impact on the prostate motion and clinical outcomes in image-guided SSPT. Careful attention to BV change is still needed when the seminal vesicle is to be treated. Advances in knowledge: Our data demonstrated that there was no apparent relationship between BV changes and prostate position reproducibility and simple verbal instruction about urination could be sufficient for image-guided SSPT.

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Section: Discussionsupporting

confidence: 90%

Are simple verbal instructions sufficient to ensure that bladder volume does not deteriorate prostate position reproducibility during spot scanning proton therapy?

et al. 2021

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“… 36 Although unable to measure bladder volume because of the restricted field of view on the CBCT, it was identified that differences in bladder volume between CT planning and treatment were present. Treating with an empty bladder may provide a more reproducible and reliable method of ensuring consistency between treatments and reduced intra-fraction motion 37 but potentially at the expense of increased total bladder dose.…”

Section: Discussionmentioning

confidence: 99%

Prostate stereotactic body radiotherapy: quantifying intra-fraction motion and calculating margins using the new BIR geometric uncertainties in daily online IGRT recommendations

McNeice

Sanikumar

Alexander

et al. 2023

BJR

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Objectives: To measure the magnitude of intra fraction prostate motion (IFPM) during stereotactic radiotherapy (SBRT) delivered without intrafraction tracking. To assess if current margins adequately cover IFPM. To derive margins using new guidelines Methods: IFPM was determined in 20 patients receiving 36.25 Gy in 5 fractions using 97 pairs of pre and post treatment cone beam CT (CBCT) scans. Correlation of time between CBCT acquisitions and motion was determined. The magnitude of IFM was compared to current margins (6 mm isotropic, 3 mm posterior). Margins were calculated using IFM alone and updated guidelines. The averaged 3D root mean square IFPM was 2.5 mm (4.2 mm). Independent prostate motion was predominantly posterior (70%) and inferior (63%). There was weak correlation between posterior (ρ = 0.38) and inferior (ρ = 0.36) IFPM and time. IFPM greater than current margins occurred in eight of 97 fractions, six in the posterior direction. Margins were ≤3.5 mm using IFM alone and ≤3.3 mm Left3.5mm Right, 7.0 mm inferior, 3.7 mm superior, 4.4 mm anterior and 3.3 mm posterior using new guidelines, compensating for motion in 92% of fractions. Conclusions: Our current SBRT margins account for 92% of IFPM, predominantly posterior and inferior. Although updated guidelines suggest an increase in margins inferiorly, any increase must be balanced against the possibility of increased toxicity, particularly if biochemical control and side-effects are favourable with current practice. Advances in knowledge: The difference between current clinical margins and those determined using updated guidance is demonstrated. The implications must be considered against clinical outcomes.

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“…The inconsistent bladder filling regardless of the protocol used, led multiple groups to investigate treating prostate cancer with radiation therapy on empty bladder. The rationale is that it is easier to obtain consistently empty bladder than a full one, while trying to reduce bowel dose by rigorous treatment planning [14,24,25]. Consistent empty bladder throughout the treatment needs continuous drainage with a Foley catheter especially when using ultrahypofrationaed doses [14].…”

Section: Discussionmentioning

confidence: 99%

“…Due to the challenges of obtaining consistently full bladder, some groups proposed utilizing consistently empty bladder when treating the prostate gland and seminal vesicles only with RT [14,24,25]. Chetiyawardana et al reported that empty bladder filling protocol of EBRT for localized prostate cancer resulted in noninferior treatment outcomes compared to patients treated with full bladder [24]. Greco et al utilized a Foley catheter to empty the bladder during 24 Gy single fraction RT to the prostate, and reported that the treatment can be safely delivered, with low acute toxicity [14].…”

Section: Empty Bladder As a Strategy For Reproducing Consistent Bladder Fillingmentioning

confidence: 99%

Maintaining consistent bladder filling during external beam radiotherapy for prostate cancer

Nasser

Fenig

Klein

et al. 2021

Technical Innovations & Patient Support in Radiation Oncolo

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Radiation therapy for patients with prostate cancer is preferably provided with a full urinary bladder. Full bladder can potentially move the small intestine out of the radiation treatment regions, and results in decreased small bowel radiation dose and gastrointestinal toxicity. Maintaining consistent bladder filling during computerized tomography simulation scan used for treatment planning and at daily radiation treatments is challenging. Here we present an in-development urinary catheter with a floating balloon that drains the bladder only when urine reaches to a prespecified level, and review current methods used in clinic to ensure consistent bladder filling. These includes bladder filling protocols, ultrasound scanning and biofeedback techniques.

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The implementation of an empty bladder filling protocol for localised prostate volumetric modulated arctherapy (VMAT): early results of a single institution service evaluation

Cited by 6 publications

References 19 publications

Are simple verbal instructions sufficient to ensure that bladder volume does not deteriorate prostate position reproducibility during spot scanning proton therapy?

Are simple verbal instructions sufficient to ensure that bladder volume does not deteriorate prostate position reproducibility during spot scanning proton therapy?

Prostate stereotactic body radiotherapy: quantifying intra-fraction motion and calculating margins using the new BIR geometric uncertainties in daily online IGRT recommendations

Maintaining consistent bladder filling during external beam radiotherapy for prostate cancer

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