Which bowel preparation is best? Comparison of a high-fibre diet leaflet, daily microenema and no preparation in prostate cancer patients treated with radical radiotherapy to assess the effect on planned target volume shifts due to rectal distension

Abstract

The use of microenema is effective in reducing prostate shift and rectal CSA, consequently decreasing the incidence of geographical miss.

ACR Appropriateness Criteria ® external beam radiation therapy treatment planning for clinically localized prostate cancer, part I of II

“…Although institutional guidelines may vary, it is reasonable to instruct patients to strive for consistency with a comfortably full bladder, an empty rectum, and an antiflatulent diet for both simulation and treatment. Given the availability of online daily image guidance strategies for prostate EBRT, which minimize geographic misses of the prostate target volume, 96 preparation guidelines should not create excessive discomfort or inconvenience for patients 97 . Finally, the use of contrast (intravenous, intravesicular/ureteral, rectal) is generally not necessary for routine care.…”

A systematic review: Effectiveness of rectal emptying preparation in prostate cancer patients

“…28,29 This diversity may render it impossible for diet prescriptions or results from one center to be generalized to another. In addition, fermentation of foods by bowel flora ("microbiota") is a major source of gas in the large intestine and is highly variable between individuals and affected by 16 See Table 2 Yahya 17 See Table 3 Darud 19 See Table 2 Graf 23 See Table 3 CBCT, cone beam computed tomography; CT, computed tomography; PM, prostate motion; RC, rectal changes; RV, rectal volume.…”

“…Ten of the 18 studies employed more than 1 intervention limiting the conclusions that can be drawn from them 8,9,11,14,16,[19][20][21][22][23] (Table 1). Eleven studies reported significant results [8][9][10][11][12][15][16][17][18]20 (Tables 2-5). …”

“…Three studies investigated the use of enemas as a single intervention and found some reduction of rectal volume or prostate motion 13,17,24 (Table 3). The remaining 2 studies used enemas in combination with rectal emptying 22 and rectal emptying and diet 23 and reported reduced prostate motion compared with earlier published results (Table 3).…”

“…Dietary advice as a single intervention was investigated in only 3 studies and although the diets varied, high fiber 11 and antiflatulent, 8,17 no difference was reported in any study between dietary and nonintervention groups. Indeed, in 1 study a significant difference in favor of the nonintervention and intrafraction prostate motion was found.…”