Dose-volume histogram evaluation of prone and supine patient position in external beam radiotherapy for cervical and endometrial cancer

Pinkawa, Michael; Gagel, Bernd; Demirel, Cengiz Bekir; Schmachtenberg, A.; Asadpour, Branka; Eble, Michael J.

doi:10.1016/s0167-8140(03)00244-5

Cited by 28 publications

(16 citation statements)

References 25 publications

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“…In the 3D-CRT of rectal malignancies, a prone treatment position without a belly board compared to a supine posture results in the reduction of the irradiated small intestine volume [33]. In case of pelvic malignancies, a larger decrease in the small intestine exposure can be obtained by the additional use of a belly board in comparison with both prone position alone [34,35] or supine position [36,37]. The use of IMRT technique decreases bowel doses by 40-50%, as compared to 3D-CRT [38,39].…”

Section: Discussionmentioning

confidence: 99%

Prone Positioning on a Belly Board Decreases Rectal and Bowel Doses in Pelvic Intensity-Modulated Radiation Therapy (IMRT) for Prostate Cancer

Kószó

Varga

Fodor

et al. 2018

Pathol. Oncol. Res.

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The presence of normal tissues in the irradiated volume limits dose escalation during pelvic radiotherapy (RT) for prostate cancer. Supine and prone positions on a belly board were compared by analyzing the exposure of organs at risk (OARs) using intensity modulated RT (IMRT). The prospective trial included 55 high risk, localized or locally advanced prostate cancer patients, receiving definitive image-guided RT. Computed tomography scanning for irradiation planning was carried out in both positions. Gross tumor volume, clinical and planning target volumes (PTV) and OARs were delineated, defining subprostatic and periprostatic rectal subsegments. At the height of the largest antero-posterior (AP) diameter of the prostate, rectal diameters and distance from the posterior prostate wall were measured. IMRT plans were generated. Normal tissue exposure and structure volumes were compared between supine and prone plans using paired t-test. In the volumes of the prostate, PTV, colon and small bowel, no significant differences were found. In prone position, all rectal volumes, diameters, and rectum-prostate distance were significantly higher, the irradiated colon and small bowel volume was lower in dose ranges of 20-40 Gy, and the exposure to all rectal segments was more favorable in 40-75 Gy dose ranges. No significant difference was found in the exposure of other OARs. Prone positioning on a belly board is an appropriate positioning method aiming rectum and bowel protection during pelvic IMRT of prostate cancer. The relative reduction in rectal exposure might be a consequence of the slight departure between the prostate and rectal wall.

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Section: Discussionmentioning

confidence: 99%

Prone Positioning on a Belly Board Decreases Rectal and Bowel Doses in Pelvic Intensity-Modulated Radiation Therapy (IMRT) for Prostate Cancer

Kószó

Varga

Fodor

et al. 2018

Pathol. Oncol. Res.

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“…The risk of developing treatment related side effects depends strongly on the delivered dose, the irradiated volume, and any previous pelvic or abdominal surgery [11-17,43]. In the prone position, decreased dose to the small bowel was achieved by using bowel displacement devices [18-23]. The use of IMRT in clinical routine might decrease the risk for acute and late toxicity in patients after pelvic or paraaortic irradiation with comparable outcome [28,29,33,34,44-47].…”

Section: Discussionmentioning

confidence: 99%

“…In the past, efforts were made to reduce the incidence and severity of gastrointestinal toxicity. Pelvic radiotherapy in prone position on a belly-board device resulted in a significant sparing of small bowel [18-23]. A recent study showed that patient set-up in prone position is subject to larger systematic errors, but the set-up in supine position harbours larger random errors [24].…”

Section: Introductionmentioning

confidence: 99%

Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning

et al. 2010

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BackgroundChemoradiation for cervical cancer patients is associated with considerable gastrointestinal toxicity. Intensity-modulated radiotherapy (IMRT) has demonstrated superiority in terms of target coverage and normal tissue sparing in comparison to conventional 3D planning in gynaecological malignancies. Whether IMRT in prone (PP) or supine position (SP) might be beneficial for cervical cancer patients remains partially unanswered.Methods10 patients on FIGO stage IB-III cervical cancer, 6 patients for definitive and 4 patients for adjuvant external beam pelvic RT, were planned in PP and SP using a 7-field IMRT technique. IMRT plans for PP and SP (mean dose, Dmean 50.4 Gy) were optimized in terms of PTV coverage (1st priority) and small bowel sparing (2nd priority). A comparison of DVH parameters for PTV, small bowel, bladder, and rectum was performed.ResultsThe comparison showed a similar PTV coverage of 95% of the prescribed dose and for target conformity in IMRT plans (PP, SP). PTV, rectum and bladder volumes were comparable for PP and SP. Significantly larger volumes of small bowel were found in PP (436 cc, + 35%, p = 0.01). PP decreased the volume of small bowel at 20-50.4 Gy (p < 0.05) and increased the rectum volumes covered by doses from 10-40 Gy (p < 0.01), the V50.4 was < 5% in both treatment positions. Bladder sparing was significant better at 50.4 Gy (p = 0.03) for PP.ConclusionIn this dosimetric study, we demonstrated that pelvic IMRT in prone position for patients with cervical cancer seems to be beneficial in reducing small bowel volume at doses ≥20 Gy while providing similar target coverage and target conformity. The use of frequent image guidance with KV (kilovolt) or MV (megavolt) computertomography can reduce set-up deviations, and treatment in prone position can be done with a higher set-up accuracy. Clinical outcome studies are needed to affirm lower toxicity.

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“…Background: The use of planar, kilovoltage x-ray images for treatment verification in radiotherapy has improved treatment accuracy. 1,2,3,4 For obese patients, where image quality is compromised, local, 5 national 2 and international 6,7,8,9 treatment verification guidelines do not specify how the images should be acquired to achieve adequate quality for treatment verification. Objectives: The diagnosis of early stage breast cancer is increasing, accurate target localisation for Partial Breast Irradiation (PBI) and boost Radiation Therapy (RT) is essential to reduce the risk of recurrence.…”

Section: University Of South Australia Adelaide Australiamentioning

confidence: 99%

Student Conference Abstracts

2017

J of Medical Radiation Sci

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During their education, medical radiation science (MRS) students learn and develop capacity for effective patient care. As postgraduate MRS professionals gain experience, we learn to juggle the demands of providing high quality patient care in a complex technological environment. It is inevitable that, at some time during our careers, our personal experiences will intersect with our professional practice. Such intersections provide us with an opportunity to view our patient care from a changed perspective. In 2005, Clinton Heal was diagnosed with melanoma at the age of 22 years. Since that time, he has experienced care as a patient in surgery, radiation therapy, radiology, chemotherapy and immunotherapy. His experiences of receiving care have coincided with his work providing care as a radiographer and CT specialist. This intersection of perspectives as both provider and receiver of patient care, coupled with Clinton's determination and resilience, has seen him emerge as a leading advocate for melanoma awareness, information and support services. This presentation will challenge us to consider our own practice from the perspective of the people in our care, as well as the opportunity to assess where we as individuals sit on the reactive -proactive health spectrum. CyberKnife: an Australian experience Gemma WatersSir Charles Gairdner Hospital, Nedlands, Australia Sir Charles Gairdner Hospital was lucky enough to install Australia's first CyberKnife Machine in January 2014, with the first patient treated clinically at the start of April 2014. The CyberKnife is a unique Radiosurgical tool unlike any other machine in Australia. It has the ability to deliver ablative doses with sub millimetre accuracy to a range of areas throughout the body. CyberKnife has the ability to track moving tumours in real time, which is a real stand out feature for this amazing machine. The CyberKnife has been clinical for almost 3 years at SCGH. My presentation will aim to give a background of the CyberKnife and the different treatment capabilities and modalities experienced at SCGH. With the experience of treating over 800 patients, our team has had to be inventive and come up with some unique techniques in treating these patients. Interesting case studies will be presented, with a focus on the range of sites the CyberKnife can treat. Objective: To identify and justify current and potential uses of 3D-printed accessories for radiation therapy (RT), with consideration of costs, dosimetry, workflow and patient outcomes. This paper is an evaluation of current research and consideration of future applications. Method: A systematic review of literature published after January 1st 2011 has located papers from databases and non-traditional sources. The MeSH term "Printing, Three-Dimensional" was introduced in 2015 and papers before 2014 are scarce. In light of this we anticipate data collection will continue until shortly before final submission. Results: 3D-printed personalised bolus, brachytherapy templates and immobilisation devices emerged ...

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Dose-volume histogram evaluation of prone and supine patient position in external beam radiotherapy for cervical and endometrial cancer

Cited by 28 publications

References 25 publications

Prone Positioning on a Belly Board Decreases Rectal and Bowel Doses in Pelvic Intensity-Modulated Radiation Therapy (IMRT) for Prostate Cancer

Prone Positioning on a Belly Board Decreases Rectal and Bowel Doses in Pelvic Intensity-Modulated Radiation Therapy (IMRT) for Prostate Cancer

Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning

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