Reduced motion and improved rectal dosimetry through endorectal immobilization for prostate stereotactic body radiotherapy

Leon, Jeremiah de; Jameson, Michael; Rivest-Hénault, David; Keats, Sarah; Rai, Robba; Arumugam, Sankar; Wilton, Lee; Ngo, Diana; Liney, Gary; Moses, Daniel; Dowling, Jason; Martin, Jarad; Sidhom, Mark

doi:10.1259/bjr.20190056

Cited by 16 publications

(14 citation statements)

References 24 publications

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“…( 32 ) were interested in the influence of the hydrogel spacer on the intra-fraction motions during irradiation with MRI-LINAC, and it was reported that the pitch rotation decreased significantly due to the use of this strategy. The use of the endorectal balloon or hydrogel spacer in SBRT is a possible option that has shown benefits, particularly in dosimetry ( 35 , 36 ).…”

Section: Discussionmentioning

confidence: 99%

Studies of Intra-Fraction Prostate Motion During Stereotactic Irradiation in First Irradiation and Re-Irradiation

et al. 2021

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BackgroundUnderstanding intra-fractional prostate motions is crucial for stereotactic body radiation therapy (SBRT). No studies have focused on the intra-fractional prostate motions during re-irradiation with SBRT. The objective was to evaluate these translational and rotational motions in primary treated patients and in the context of re-irradiation.MethodsFrom January 2011 to March 2020, 162 patients with histologically proven prostate cancer underwent prostate SBRT, including 58 as part of a re-irradiation treatment. We used the continuous coordinates of the fiducial markers collected by an orthogonal X-ray dual-image monitoring system. The translations and rotations of the prostate were calculated. Prostate deviations representing overall movement was defined as the length of the 3D-vectors.ResultsA total of 858 data files were analyzed. The deviations over time in the group of primary treated patients were significantly larger than that of the group of re-irradiation, leading to a mean deviation of 2.73 mm (SD =1.00) versus 1.90 mm (SD =0.79), P<0.001. In the re-irradiation group, we identified displacements of -0.05 mm (SD =1.53), 0.20 mm (SD =1.46); and 0.42 mm (SD =1.24) in the left-right, superior-inferior and anterior-posterior planes. Overall, we observed increasing deviations over the first 30 min followed by a stabilization related to movements in the three translational axes.ConclusionThis is the first study to focus on intrafraction prostate motions in the context of re-irradiation. We observed that intra-fraction prostate motions persisted in the setting of re-irradiation, although they showed a significant reduction when compared with the first irradiation. These results will help to better estimate random errors during SBRT treatment of intra-prostatic recurrence after irradiation.

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Section: Discussionmentioning

confidence: 99%

Studies of Intra-Fraction Prostate Motion During Stereotactic Irradiation in First Irradiation and Re-Irradiation

et al. 2021

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“…Previous study by Mahdavi et al has been demonstrated that using a rectal retractor during dose-escalated prostate, EBRT not only reduces the posterior rectal wall doses but also it can significantly decrease radiation doses to the anterior rectal wall (15). Furthermore, the rectal retractor can reduce interand intra-fraction prostate motions (42,43). The use of endorectal balloon can also significantly reduce radiation doses to the posterior rectal wall (9).…”

Section: Discussionmentioning

confidence: 99%

Optimization of prostate brachytherapy techniques with polyethylene glycol–based hydrogel spacers: A systematic review

Ardekani

Ghaffari

2020

Brachytherapy

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The objective of this overview was to critically evaluate the effect of polyethylene glycol (PEG)-based hydrogel spacers during prostate brachytherapy with regard to dosimetric and clinical benefits, as well as procedure-related toxicity. METHODS AND MATERIALS: A systematic search in the PubMed database was performed. RESULTS: A total of 12 studies, involving 615 patients with PEG hydrogel injection, were included. Overall, patients well tolerated the implantation of PEG hydrogel spacers with an excellent safety profile. However, although there were some procedure-related complications, rates of these complications were very rare. Toxicities related to the spacer were limited to Grade 1 rectal discomfort and pain (9/615 patients), Grade 2 rectal ulceration (1 in 615 patients), perineal abscess (1 in 615 patients), and bacterial prostatitis (2/615 patients) according to Common Terminology Criteria for Adverse Events v4.0 grading scheme. The application of PEG hydrogel spacers significantly reduced radiation doses to the rectum during prostate brachytherapy in the different setting. Although there was no prospective randomized clinical trial, retrospective studies showed that reducing rectal doses by the implantation of PEG hydrogel may result in an improvement in rectal toxicity. CONCLUSIONS: The insertion of hydrogel spacers is safe, resulting in a significant decrease in rectal doses. This may lead to a reduction in rectal or gastrointestinal toxicity. Prospective randomized clinical trials are warranted to confirm the clinical impact of rectal dosimetric improvements.

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“…Therefore, radiotherapy combined with capecitabine in rectal cancer patients after neoadjuvant therapy has great advantages [ 19 , 20 ]. In recent years, many scholars have proposed that radiotherapy combined with capecitabine in rectal cancer patients after neoadjuvant therapy can reduce patients' adverse reactions and has a positive effect on improving patients' survival rate [ 21 , 22 ]. In this study, in order to investigate the clinical effect of radiotherapy combined with capecitabine in rectal cancer patients after neoadjuvant therapy, the patients in the control group were treated with radiotherapy, while the patients in the experimental group were treated with radiotherapy combined with capecitabine.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effect of Radiotherapy Combined with Capecitabine after Neoadjuvant Therapy for Rectal Cancer

Zhang

Teng

2021

Journal of Oncology

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Objective. The purpose of the study was to investigate the clinical effect of radiotherapy combined with capecitabine in rectal cancer patients after neoadjuvant therapy. Methods. 80 rectal cancer patients who underwent neoadjuvant therapy in our hospital from February 2016 to February 2018 were selected as the study subjects and divided into the control group (n = 40) and experimental group (n = 40) according to the order of admission. Among them, the control group was treated with radiotherapy, while the experimental group was treated with radiotherapy combined with capecitabine. The therapeutic efficacy, CEA levels, the incidence and recurrence rate of adverse reactions, as well as the progression-free survival and survival rate after 2-year treatment were analyzed in the two groups. Results. The effective rate of treatment in the experimental group of 87.5% (35/40) was significantly higher than 50% (20/40) in the control group, with statistical significance (X2 = 13.09, P < 0.001 ). After treatment, the CEA levels in the two groups both decreased significantly, and the CEA level in the experimental group of 3.75 ± 1.76 ng/ml was significantly lower than 7.35 ± 2.11 ng/ml in the control group, with statistical significance (T = 8.29, P < 0.001 ). The incidence and the recurrence rate of adverse reactions of 5% (2/40) and 10% (4/40), respectively, in the experimental group were significantly lower than those of 40% (16/40) and 30% (12/40) in the control group, with statistical significance (X2 = 14.05, 5.00, P < 0.001 , 0.05). After the 2-year follow-up, it was found that the progression-free survival of 21.53 ± 6.23 months in the experimental group was significantly longer than that of 18.18 ± 5.41 months in the control group, with statistical significance (T = 2.57, P < 0.05 ), and the 2-year survival rate of 97.5% (39/40) in the experimental group was significantly higher than 80% (32/40) in the control group, with statistical significance (T = 6.13, P < 0.05 ). Conclusion. Radiotherapy combined with capecitabine in rectal cancer patients after neoadjuvant therapy can improve the therapeutic efficacy with fewer adverse reactions and longer patients’ survival, which is worthy of popularization and application after neoadjuvant therapy for rectal cancer.

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Reduced motion and improved rectal dosimetry through endorectal immobilization for prostate stereotactic body radiotherapy

Cited by 16 publications

References 24 publications

Studies of Intra-Fraction Prostate Motion During Stereotactic Irradiation in First Irradiation and Re-Irradiation

Studies of Intra-Fraction Prostate Motion During Stereotactic Irradiation in First Irradiation and Re-Irradiation

Optimization of prostate brachytherapy techniques with polyethylene glycol–based hydrogel spacers: A systematic review

Clinical Effect of Radiotherapy Combined with Capecitabine after Neoadjuvant Therapy for Rectal Cancer

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