Zusammenfassung
HINTERGRUND: In der 3 dimensionalen Radiotherapie des lokalisierten Prostatakarzinoms wird zur Fixierung der Prostata und zur Verminderung der Strahlendosis an der Rektumhinterwand ein Rektumballon verwendet. Ziel dieser Studie war die Evaluierung der klinischen Anwendbarkeit eines Rektumballonkatheters, dessen Patientenakzeptanz und Untersuchung des Einflusses von akuten rektalen Nebenwirkungen und prätherapeutisch detektierten Hämorrhoiden auf die Ballonverträglichkeit. MATERIAL UND METHODE: 442 Patienten mit lokalisiertem Prostatakarzinom wurden im Rahmen einer prospektiven österreichisch-deutschen Multicenter-Studie evaluiert. Die Gesamtherddosis betrug 70 bzw. 74 Gray. Die Ballonverträglichkeit (1. Keine Beschwerden; 2. Schmerzen bei/während der Applikation; 3. Zeichen von Blut am Ballonkatheter nach Applikation ohne Schmerzen; 4. Zeichen von Blut am Ballonkatheter nach Applikation und Schmerzen; 5. Abbruch der Ballonapplikation) und akuten rektalen Nebenwirkungen wurden während der Radiotherapie (Beginn/Mitte/Ende) ermittelt. 310 Patienten willigten in eine Rektoskopie vor Beginn der Therapie ein. RESULTATE: 429/442 der Patienten (97 %) wurden mit Rektumballon bestrahlt. Dabei berichteten 79 % über keine Beschwerden. Die Ballonapplikation musste bei nur 4 % der Patienten abgebrochen werden. Grad 0 akute rektale Nebenwirkungen fanden sich bei 52 %, Grad 1 bei 31 %, Grad 2 und 3 bei 17 % und 0,5 %. Es zeigte sich eine signifikante Korrelation zwischen Rektumballonbeschwerden und rektalen Nebenwirkungen (p < 0,01). Bei 36 % der Patienten fanden sich Hämorrhoiden ohne einen Einfluss auf die Ballonverträglichkeit zu zeigen. SCHLUSSFOLGERUNG: Der Rektumballon wird von einem Großteil der Patienten im Rahmen der 3-dimensionalen Strahlentherapie des lokalisierten Prostatakarzinoms gut vertragen und kann im klinischen Alltag sicher verwendet werden. Während Patienten mit akuten rektalen Nebenwirkungen signifikant häufiger über Beschwerden bzgl. des Rektumballonkatheters berichteten, zeigte das Vorliegen von Hämorrhoiden keinen Einfluss.
Summary
PURPOSE: Patients with localized prostate cancer are treated with 3D radiotherapy using a rectal balloon catheter for internal immobilization of the prostate, thereby reducing the radiation dose to the dorsal rectal wall. The purpose of the study was to investigate clinical feasibility and the influence of acute rectal side effects and pre-existing hemorrhoids on patients' acceptance of the rectal balloon catheter. METHODS AND MATERIALS: 442 patients who underwent primary radiation therapy for localized prostate cancer were included in this prospective Austrian-German multicenter trial. The total radiation dose was either 70 Gy or 74 Gy. Acute rectal side effects were documented using the EORTC/RTOG grading score (European Organisation for Research and Treatment of Cancer/Radiation Therapy 225 Oncology Group) at weeks 2, 4 and 7 of radiation treatment. Within the same time intervals patients were interviewed about their tolerance of the rectal balloon catheter, evaluating five categories of acceptance (1 = no major complaints, 2 = pain at/during application, 3 = signs of blood at the balloon catheter after application but without any pain, 4 = signs of blood at the balloon catheter after application and pain, 5 = balloon application had to be stopped). Voluntary rectoscopy prior to radiotherapy was performed in 310 patients. RESULTS: 429/442 patients (97 %) were treated with the balloon catheter. No major complaints were reported in 79 % of the patients and no acute rectal side effects were seen in 52 % of the patients. Grade 1 side effects were seen in 31 % patients, Grade 2 in 17 % and Grade 3 in 0.5 %. Balloon use had to be stopped in only 4 % of the patients. There was significant correlation between balloon discomfort and rectal side effects (p < 0.01). The presence of hemorrhoids in 36 % patients prior to irradiation had no influence on balloon tolerance. CONCLUSIONS: The rectal balloon can be used in 3D radiotherapy of localized prostate cancer with a high degree of acceptance by the patients. Use of the balloon is safe within daily clinical treatment. Patients reporting acute rectal side effects experienced significantly more balloon discomfort, but the presence of hemorrhoids was not found to influence acceptance of the balloon.
This is a preview of subscription content, log in via an institution to check access.
References
Vutuc C, Schernhammer ES, Haidinger G, Waldhor T (2005) Prostate cancer and prostate-specific antigen (PSA) screening in Austria. Wien Klin Wochenschr 117: 457–461
Dearnaley DP, Khoo VS, Norman AR, Meyer L, Nahum A, Tait D, et al (1999) Comparison of radiation side effects of conformal and conventional radio-therapy in prostate cancer: A randomised trial. Lancet 353: 267–272
Hartford AC, Niemierko A, Adams JA, Urie MM, Shipley WU (1996) Conformal irradiation of the prostate: estimating long-term rectal bleeding risk using dose-volume histograms. Int J Radiat Oncol Biol Phys 36: 721–730
Pollack A, Hanlon AL, Horwitz EM, Feigenberg SJ, Uzzo RG, Hanks GE (2004) Prostate cancer radiotherapy dose response: an update of the fox chase experience. J Urol 171: 1132–1136
Hanks GE, Hanlon AL, Schultheiss TE, Pinover WH, Movsas B, Epstein BE, et al (1998) Dose escalation with 3D conformal treatment: five year outcomes, treatment optimization, and future directions. Int J Radiat Oncol Biol Phys 41: 501–510
Michalski JM, Purdy JA, Winter K, Roach M 3rd, Vijayakumar S, Sandler HM, et al (2000) Preliminary report of toxicity following 3D radiation therapy for prostate cancer on 3DOG/RTOG 9406. Int J Radiat Oncol Biol Phys 46: 391–402
Zelefsky MJ, Leibel SA, Gaudin PB, Kutcher GJ, Fleshner NE, Venkatramen ES, et al (1998) Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 41: 491–500
Koelbl O, Schwab F, Bratengeier K, Vordermark D, Flentje M (2005) Radiotherapy of prostate cancer with multileaf collimators (MLCs) optimization of the undulating dose distribution at the MLC edge. Strahlenther Onkol 181: 108–112
Schwarz R, Krull A, Tribius S, Alberti W (2005) Results of three dimensional conformal radiotherapy and hormonal therapy for local recurrence after radical prostatectomy. Strahlenther Onkol 181: 442–447
Tait DM, Nahum AE, Meyer LC, Law M, Dearnaley DP, Horwich A, et al (1997) Acute toxicity in pelvic radiotherapy; a randomized trial of conformal versus conventional treatment. Radiother Oncol 42: 121–136
Aebersold DM, Isaak B, Thalmann G, Behrensmeier F, Kolotas C, Kranzbuhler H, et al (2004) Applicability and dosimetric impact of ultrasound-based preplanning in high-dose-rate brachytherapy of prostate cancer. Strahlenther Onkol 180: 351–357
Kuban DA, Dong L, Cheung R, Strom E, De Crevoisier R (2005) Ultrasound-based localization. Semin Radiat Oncol 15: 180–191
Mohan DS, Kupelian PA, Willoughby TR (2000) Shortcourse intensity-modulated radiotherapy for localized prostate cancer with daily transabdominal ultrasound localization of the prostate gland. Int J Radiat Oncol Biol Phys 46: 575–580
Schaly B, Bauman GS, Battista JJ, Van Dyk J (2005) Validation of contour-driven thin-plate splines for tracking fraction-to-fraction changes in anatomy and radiation therapy dose mapping. Phys Med Biol 50: 459–475
Beaulieu L, Girouard LM, Aubin S, Aubry JF, Brouard L, Roy-Lacroix L, et al (2004) Performing daily prostate targeting with a standard V-EPID and an automated radioopaque marker detection algorithm. Radiother Oncol 73: 61–64
Henry AM, Wilkinson C, Logue JP, Price P, Khoo VS (2004) Trans-perineal implantation of radio-opaque treatment verification markers into the prostate: an assessment of procedure related morbidity, patient acceptability and accuracy. Radiother Oncol 73: 57–59
Bakai A, Paulsen F, Plasswilm L, Bamberg M, Nusslin F (2002) Positioning accuracy in conformational prostatic irradiation using portal imaging. Strahlenther Oncol 178: 84–90
Geinitz H, Zimmermann FB, Kuzmany A, Kneschaurek P (2000) Daily CT planning during boost irradiation of prostate cancer. Feasibility and time requirements. Strahlenther Onkol 176: 429–432
Ciernik IF, Baumert BG, Egli P, Glanzmann C, Lutolf UM (2002) On-line correction of beam portals in the treatment of prostate cancer using an endorectal balloon device. Radiother Oncol 65: 39–45
D'Amico AV, Manola J, Loffredo M, Renshaw AA, Della-Croce A, Kantoff PW (2001) A practical method to achieve prostate gland immobilization and target verification for daily treatment. Int J Radiat Oncol Biol Phys 51: 1431–1436
Gerstner N, Wachter S, Dorner D, Goldner G, Colotto A, Potter R (1999) Die Bedeutung eines Rektumballons als interne Immobilisation bei der konformalen Strahlentherapie des Prostatakarzinoms. Strahlenther Onkol 175: 232–238
Patel RR, Orton N, Tome WA, Chappell R, Ritter MA (2003) Rectal dose sparing with a balloon catheter and ultrasound localization in conformal radiation therapy for prostate cancer. Radiother Oncol 67: 285–294
Teh BS, McGary JE, Dong L, Mai WY, Carpenter LS, Lu HH, et al (2002) The use of rectal balloon during the delivery of intensity modulated radiotherapy (IMRT) for prostate cancer: more than just a prostate gland immobilization device? Cancer J 8: 476–483
Wachter S, Gerstner N, Dorner D, Goldner G, Colotto A, Wambersie A, et al (2002) The influence of a rectal balloon tube as internal immobilization device on variations of volumes and dose-volume histograms during treatment course of conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 52: 91–100
Bastasch MD, Teh BS, Mai WY, McGary JE, Grant WH 3rd, Butler EB (2006) Tolerance of endorectal balloon in 396 patients treated with intensity-modulated radiation therapy (IMRT) for prostate cancer. Am J Clin Oncol 29: 8–11
Hille A, Schmidberger H, Tows N, Weiss E, Vorwerk H, Hess CF (2005) The impact of varying volumes in rectal balloons on rectal dose sparing in conformal radiation therapy of prostate cancer. A prospective three-dimensional analysis. Strahlenther Onkol 181: 709–716
Crespi M, Delvaux M, Schapiro M, Venables C, Zwiebel F (1996) Working report by the committee for minimal standards of terminology and documentation in digestive endoscopy of the European Society for Gastrointestinal Endoscopy. Minimal standard terminology for computerized endoscopic data base. Ad hoc task force of the committee. Am J Gastroenterol 91: 191–216
Wachter S, Gerstner N, Goldner G, Potzi R, Wambersie A, Potter R (2000) Endoscopic scoring of late rectal mucosal damage after conformal radiotherapy for prostatic carcinoma. Radiother Oncol 54: 11–19
Tsai HK, Manola J, Abner A, Talcott JA, D'Amico AV, Beard C (2005) Patient-reported acute gastrointestinal toxicity in men receiving 3-dimensional conformal radiation therapy for prostate cancer with or without neoadjuvant androgen suppression therapy. Urol Oncol 23: 230–237
Peeters ST, Heemsbergen WD, van Putten WL, Slot A, Tabak H, Mens JW, et al (2005) Acute and late complications after radiotherapy for prostate cancer: results of a multicenter randomized trial comparing 68 Gy to 78 Gy. Int J Radiat Oncol Biol Phys 61: 1019–1034
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goldner, G., Geinitz, H., Wachter, S. et al. 3-D Conformal radiotherapy of localized prostate cancer within an Austrian–German multicenter trial: a prospective study of patients' acceptance of the rectal balloon during treatment. Wien Klin Wochenschr 118, 224–229 (2006). https://doi.org/10.1007/s00508-006-0588-z
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00508-006-0588-z