Abstract
Purpose
Rectal volume variation has a crucial effect on prostate localization during external beam radiotherapy for prostate cancer. This study investigated the effect of rectal volume reduction by a rectum-emptying tube (RET) on prostate immobilization.
Materials and methods
The study group comprised 21 patients who underwent proton beam treatment for prostate cancer. Sigmoid-shaped flexible plastic RETs were used to drain gases from the rectum. Computed tomography (CT) was performed before and after RET placement at the treatment planning stage and at the beginning of treatment. Prostate displacement and changes in rectal volume were measured on the CT images. The feasibility of RET placement was evaluated during and after the procedure.
Results
All 21 patients tolerated the procedure. The rectal volume was significantly lower with a RET than without a RET. The differences in rectal volume between the treatment planning stage and the beginning of treatment were significantly lower with a RET than without. RET placement significantly decreased prostate displacement in the anteroposterior and superoinferior directions but not in the left-right direction.
Conclusion
RET placement reduced both rectal volume and variation in rectal volume. The procedure reduced displacement of the prostate. RET placement thus appears to be an effective technique for immobilizing the prostate.
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References
Slater JD, Rossi CJ, Jr, Yonemoto LT, Bush DA, Jabola BR, Levy RP, et al. Proton therapy for prostate cancer: the initial Loma Linda University experience. Int J Radiat Oncol Biol Phys 2004;59:348–352.
Zelefsky MJ, Chan H, Hunt M, Yamada Y, Shippy AM, Amols H, et al. Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urol 2006;176:1415–1419.
Zelefsky MJ, Fuks Z, Hunt M, Yamada Y, Marion C, Ling CC, et al. High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys 2002;53:1111–1116.
Ciernik IF, Baumert BG, Egli P, Glanzmann C, Lütolf UM. On-line correction of beam portals in the treatment of prostate cancer using an endorectal balloon device. Radiother Oncol 2002;65:39–45.
Zelefsky MJ, Leibel SA, Gaudin PB, Kutcher GJ, Fleshner NE, Venkatramen ES, et al. Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 1998;41:491–500.
Artignan X, Smitsmans MH, Lebesque JV, Jaffray DA, Van Her M, Bartelink H. Online ultrasound image guidance for radiotherapy of prostate cancer: impact of image acquisition on prostate displacement. Int J Radiat Oncol Biol Phys 2004;59:595–601.
Trichter F, Ennis RD. Prostate localization using transabdominal ultrasound imaging. Int J Radiat Oncol Biol Phys 2003;56:1225–1233.
Little DJ, Dong L, Levy LB, Chandra A, Kuban DA. Use of portal images and BAT ultrasonography to measure setup error and organ motion for prostate IMRT: implications for treatment margins. Int J Radiat Oncol Biol Phys 2003;56:1218–1224.
Soete G, De Cock M, Verellen D, Michielsen D, Keuppens F, Storme G. X-ray-assisted positioning of patients treated by conformal arc radiotherapy for prostate cancer: com parison of setup accuracy using implanted markers versus bony structures. Int J Radiat Oncol Biol Phys 2007;67:823–827.
Serago CF, Buskirk SJ, Igel TC, Gale AA, Serago NE, Earle JD. Comparison of daily megavoltage electronic portal imaging or kilovoltage imaging with marker seeds to ultrasound imaging or skin marks for prostate localization and treatment positioning in patients with prostate cancer. Int J Radiat Oncol Biol Phys 2006;65:1585–1592.
McNair HA, Mangar SA, Coffey J, Shoulders B, Hansen VN, Norman A, et al. A comparison of CT- and ultrasound-based imaging to localize the prostate for external beam radiotherapy. Int J Radiat Oncol Biol Phys 2006;65:678–687.
De Crevoisier R, Tucker SL, Dong L, Mohan R, Cheung R, Cox JD, et al. Increased risk of biochemical and local failure in patients with distended rectum on the planning CT for prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys 2005;62:965–973.
Beard CJ, Kijewski P, Bussière M, Gelman R, Gladstone D, Shaffer K, et al. Analysis of prostate and seminal vesicle motion: implications for treatment planning. Int J Radiat Oncol Biol Phys 1996;34:451–458.
Zellars RC, Roberson PL, Strawderman M, Zhang D, Sandler HM, Ten Haken RK, et al. Prostate position late in the course of external beam therapy: patterns and predictors. Int J Radiat Oncol Biol Phys 2000;47:655–660.
Antolak JA, Rosen, II, Childress CH, Zagars GK, Pollack A. Prostate target volume variations during a course of radiotherapy. Int J Radiat Oncol Biol Phys 1998;42:661–672.
Van Herk M, Bruce A, Kroes AP, Shouman T, Touw A, Lebesque JV. Quantification of organ motion during conformal radiotherapy of the prostate by three dimensional image registration. Int J Radiat Oncol Biol Phys 1995;33:1311–1320.
Beyer GP, Scarantino CW, Prestidge BR, Sadeghi AG, Anscher MS, Miften M, et al. Technical evaluation of radiation dose delivered in prostate cancer patients as measured by an implantable MOSFET dosimeter. Int J Radiat Oncol Biol Phys 2007;69:925–935.
Crook JM, Raymond Y, Salhani D, Yang H, Esche B. Prostate motion during standard radiotherapy as assessed by fiducial markers. Radiother Oncol 1995;37:35–42.
Mah D, Freedman G, Milestone B, Hanlon A, Palacio E, Richardson T, et al. Measurement of intrafractional prostate motion using magnetic resonance imaging. Int J Radiat Oncol Biol Phys 2002;54:568–575.
Malone S, Crook JM, Kendal WS, Szanto J. Respiratoryinduced prostate motion: quantification and characterization. Int J Radiat Oncol Biol Phys 2000;48:105–109.
Wachter S, Gerstner N, Dorner D, Goldner G, Colotto A, Wambersie A, et al. 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 2002;52:91–100.
Sanghani MV, Ching J, Schultz D, Cormack R, Loffredo M, McMahon E,et al. Impact on rectal dose from the use of a prostate immobilization and rectal localization device for patients receiving dose escalated 3D conformal radiation therapy. Urol Oncol 2004;22:165–168.
D’Amico AV, Manola J, McMahon E, Loffredo M, Lopes L, Ching J, et al. A prospective evaluation of rectal bleeding after dose-escalated three-dimensional conformal radiation therapy using an intrarectal balloon for prostate gland localization and immobilization. Urology 2006;67:780–784.
Bastasch MD, Teh BS, Mai WY, McGary JE, Grant WH 3rd, Butler EB. Tolerance of endorectal balloon in 396 patients treated with intensity-modulated radiation therapy (IMRT) for prostate cancer. Am J Clin Oncol 2006;29:8–11.
Ogino I, Uemura H, Inoue T, Kubota Y, Nomura K. Okamoto N. Reduction of prostate motion by removal of gas in rectum during radiotherapy. Int J Radiat Oncol Biol Phys 2008;72:456–466.
Fiorino C, Di Muzio N, Broggi S, Cozzarini C, Maggiulli E, Alongi F, et al. Evidence of limited motion of the prostate by carefully emptying the rectum as assessed by daily MVCT image guidance with helical tomotherapy. Int J Radiat Oncol Biol Phys 2008;71:611–617.
McGary JE, Teh BS, Butler EB, Grant W 3rd. Prostate immobilization using a rectal balloon. J Appl Clin Med Phys 2002;3:6–11.
Van Lin EN, van der Vight LP, Witjes JA, Huisman HJ, Leer JW, Visser AG. The effect of an endorectal balloon and offline correction on the interfraction systematic and random prostate position variations: a comparative study. Int J Radiat Oncol Biol Phys 2005;61:278–288.
Miralbell R, Mollà M, Arnalte R, Canales S, Vargas E, Linero D, Waters S, et al. Target repositioning optimization in prostate cancer: is intensity-modulated radiotherapy under stereotactic conditions feasible? Int J Radiat Oncol Biol Phys 2004;59:366–371.
Patel RR, Orton N, Tomé WA, Chappell R, Ritter MA. Rectal dose sparing with a balloon catheter and ultrasound localization in conformal radiation therapy for prostate cancer. Radiother Oncol 2003;67:285–294.
Teh BS, Mai WY, Uhl BM, Augspurger ME, Grant WH 3rd, Lu HH, et al. Intensity-modulated radiation therapy (IMRT) for prostate cancer with the use of a rectal balloon for prostate immobilization: acute toxicity and dose-volume analysis. Int J Radiat Oncol Biol Phys 2001;49:705–712.
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The authors have no conflicts of interests to declare. The content of this article was presented at the 2008 Genitourinary Cancers Symposium, San Francisco, February 2008.
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Fuji, H., Murayama, S., Niwakawa, M. et al. Changes in rectal volume and prostate localization due to placement of a rectum-emptying tube. Jap J Radiol 27, 205–212 (2009). https://doi.org/10.1007/s11604-009-0323-6
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DOI: https://doi.org/10.1007/s11604-009-0323-6