Impact of a rectal and bladder preparation protocol on prostate cancer outcome in patients treated with external beam radiotherapy

Maggio, A.; Gabriele, Domenico; Garibaldi, E.; Bresciani, S.; Delmastro, Elena; Dia, A. Di; Miranti, A.; Poli, Matteo Umberto; Varetto, T.; Stasi, M.; Gabriele, P.

doi:10.1007/s00066-017-1163-4

Cited by 19 publications

(14 citation statements)

References 35 publications

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“…Prostate radiotherapy accuracy is impacted by the uncertainties of proximal organs at risk (OARs) such as the filling rate and volumes of the bladder and rectum [1,2]. Since 2014, majority of prostate patients at our centre have been treated using Volumetric Arc Therapy (VMAT) to reduce treatment time and thus intrafraction motion.…”

Section: Introductionmentioning

confidence: 99%

Reduction of intra-fraction prostate motion – Determining optimal bladder volume and filling for prostate radiotherapy using daily 4D TPUS and CBCT

Pang

Knight

Hussain

et al. 2018

Technical Innovations & Patient Support in Radiation Oncolo

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Background and purpose: Inconsistent bladder and rectal volumes have been associated with motion uncertainties during prostate radiotherapy. This study investigates the impact of these volumes to determine the optimal bladder volume. Materials and methods: 60 patients from two Asian hospitals were recruited prospectively. 1887 daily cone-beam computed tomography (CBCT) images were analysed. Intra-fraction motion of the prostate was monitored real-time using a four-dimension transperineal ultrasound (4D TPUS) Clarity Ò system. The impact of planned bladder volume, adequacy of daily bladder filling, and rectum volume on mean intra-fraction motion of the prostate was analysed. Patients' ability to comply with the full bladder hydration protocol and level of frustration was assessed using a questionaire. Acute side effects were assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 and quality of life (QoL) assessed using the International Prostate Symptom Score (IPSS). Results: The mean (SD) bladder and rectum volumes achieved during daily treatment were 139.7 cm 3 (82.4 cm 3) and 53.3 cm 3 (18 cm 3) respectively. Mean (SD) percentage change from planned CT volumes in bladder volume was reduced by 8.2% (48.7%) and rectum volume was increased by 12.4% (42.2%). Linear Mixed effect model analysis revealed a reduction in intra-fraction motion in both the Sup/Inf (p = 0.008) and Ant/Post (p = 0.0001) directions when the daily bladder was filled between 82 and 113% (3rd Quartiles) of the planned CT volumes. A reduction in intra-fraction motion of the prostate in the Ant/Post direction (z-plane) (p = 0.03) was observed when the planned bladder volume was greater than 200 ml. Patients complied well with the hydration protocol with minimal frustration (mean (SD) scores of 2.1 (1.4) and 1.8 (1.2) respectively). There was a moderate positive correlation (0.496) between mean bladder volume and IPSS reported post-treatment urinary straining (p = 0.001). Conclusions: A planned bladder volume >200 cm 3 and daily filling between 82 and 113%, reduced intrafraction motion of the prostate. The hydration protocol was well tolerated.

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Section: Introductionmentioning

confidence: 99%

Reduction of intra-fraction prostate motion – Determining optimal bladder volume and filling for prostate radiotherapy using daily 4D TPUS and CBCT

Pang

Knight

Hussain

et al. 2018

Technical Innovations & Patient Support in Radiation Oncolo

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“…Although modern localization modalities have significant advantages, they should not be relied upon to overcome poor simulation technique as the goal of simulation is to replicate the conditions that will be used during therapy. For example, significant rectal distension on the initial planning CT is often a compelling indication of prostate deformation and rotation about its typical configuration, and effort should be made to minimize rectal distention ( 44 ). The various IGRT methods are reviewed in more detail below.…”

Section: Techniquesmentioning

confidence: 99%

Image-guided radiotherapy for prostate cancer

Dang

Kupelian

Cao

et al. 2018

Transl. Androl. Urol.

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Intensity-modulated radiotherapy (IMRT) has become the standard radiotherapy technology utilized for the treatment of prostate cancer, as it permits the delivery of highly conformal radiation dose distributions. Image-guided radiotherapy (IGRT) is an essential companion to IMRT that allows the treatment team to account for daily changes in target anatomy and positioning. In the present review, we will discuss the different sources of geometric uncertainty and review the rationale behind using IGRT in the treatment of prostate cancer. We will then describe commonly employed IGRT techniques and review their benefits and drawbacks. Additionally, we will review the evidence suggesting a potential clinical benefit to utilizing IGRT.

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“…3 In radiation therapy, it is important to perform a secure delivery of high doses with dose minimization to adjacent organs at risk. 4,5 The accuracy of any radiation therapy is however limited by several factors, including set-up error, organ delineation, inter-and intra-fraction organ translocation, and target organ distortion. 6 Rectal distension and, to a lesser extent, bladder filling have been found to be the principal causes of prostate translocation.…”

Section: Introductionmentioning

confidence: 99%

“…6 Rectal distension and, to a lesser extent, bladder filling have been found to be the principal causes of prostate translocation. 4,[7][8][9] Despite this, there is a lack of consensus regarding the optimal degree of bladder filling during radiation therapy, with recommendations encompassing a spectrum of an empty, partially full, comfortably full or full bladder. 4,8,[10][11][12][13] Some studies have shown that radiation therapy with a full bladder protocol has distinct advantages in relation to dose load to both rectum and bladder.…”

Section: Introductionmentioning

confidence: 99%

“…4,[7][8][9] Despite this, there is a lack of consensus regarding the optimal degree of bladder filling during radiation therapy, with recommendations encompassing a spectrum of an empty, partially full, comfortably full or full bladder. 4,8,[10][11][12][13] Some studies have shown that radiation therapy with a full bladder protocol has distinct advantages in relation to dose load to both rectum and bladder. 14,15 However, a proportion of patients will struggle to maintain a full bladder protocol due to advanced age or urinary irritation, thus some authors favour an empty bladder protocol for reasons of patient comfort and the potential for improved volume reproducibility; despite initial concerns, such protocols have been shown to have a low radiation therapy bladder toxicity.…”

Section: Introductionmentioning

confidence: 99%

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Three-dimensional MRI evaluation of the effect of bladder volume on prostate translocation and distortion

Snoj

Gill

Rundo

et al. 2020

Radiology and Oncology

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BackgroundThe accuracy of any radiation therapy delivery is limited by target organ translocation and distortion. Bladder filling is one of the recognised factors affecting prostate translocation and distortion. The purpose of our study was to evaluate the effect of bladder volume on prostate translocation and distortion by using detailed three-dimensional prostate delineation on MRI.Patients and methodsFifteen healthy male volunteers were recruited in this prospective, institutional review board-approved study. Each volunteer underwent 4 different drinking preparations prior to imaging, with MR images acquired pre- and post-void. MR images were co-registered by using bony landmarks and three-dimensional contouring was performed in order to assess the degree of prostate translocation and distortion. According to changes in bladder or rectum distention, subdivisions were made into bladder and rectal groups. Studies with concomitant change in both bladder and rectal volume were excluded.ResultsForty studies were included in the bladder volume study group and 8 in the rectal volume study group. The differences in rectal volumes yielded higher levels of translocation (p < 0.01) and distortion (p = 0.02) than differences in bladder volume. Moderate correlation of prostate translocation with bladder filling was shown (r = 0.64, p < 0.01). There was no important prostate translocation when bladder volume change was < 2-fold (p < 0.01). Moderate correlation of prostate distortion with bladder filling was shown (r = 0.61, p < 0.01).ConclusionsBladder volume has a minimal effect on prostate translocation and effect on prostate distortion is negligible. Prostate translocation may be minimalised if there is < 2-fold increase in the bladder volume.

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Impact of a rectal and bladder preparation protocol on prostate cancer outcome in patients treated with external beam radiotherapy

Cited by 19 publications

References 35 publications

Reduction of intra-fraction prostate motion – Determining optimal bladder volume and filling for prostate radiotherapy using daily 4D TPUS and CBCT

Reduction of intra-fraction prostate motion – Determining optimal bladder volume and filling for prostate radiotherapy using daily 4D TPUS and CBCT

Image-guided radiotherapy for prostate cancer

Three-dimensional MRI evaluation of the effect of bladder volume on prostate translocation and distortion

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