To prep or not to prep - that is the question: A randomized trial on the use of antiflatulent medication as part of bowel preparation for patients having image guided external beam radiation therapy to the prostate

McGuffin, Merrylee; Devji, Naila; Kehoe, Lyann; Carty, Adele; Russell, Steve; Prospero, Lisa Di; DeAngelis, Carlo; Kiss, Alex; Vesprini, Danny; Loblaw, Andrew; D’Alimonte, Laura

doi:10.1016/j.prro.2017.10.012

Cited by 7 publications

(12 citation statements)

References 23 publications

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“…also looked at simethicone in prostate radiation therapy, and they found no difference in the frequency of CT simulation rescans because of unacceptably large rectal volume at the time of simulation. However, the event rate of rescans in this study was found to be almost half what is found in the general patient population 21 . Furthermore, the simethicone was commenced only 2 days prior to simulation, which our study suggests may not be early enough.…”

Section: Discussioncontrasting

confidence: 67%

Randomised controlled trial on the effect of simethicone bowel preparation on rectal variability during image‐guided radiation therapy for prostate cancer (SPoRT study)

et al. 2022

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Introduction:The purpose of this study was to assess whether simethicone reduces the rectal volume (RV) and gas volume (GV), to increase treatment accuracy and to decrease toxicity of prostate radiation therapy.Methods: 30 patients were randomised to simethicone or no intervention. Cone-beam computed tomography (CBCT) scans were performed on Days 1-3 and weekly until completion of radiation. RV and GV were measured using volume delineation. Toxicity data were collected. Results: 264 CBCTs were analysed. RV and GV were not significantly different in the simethicone group compared with the control group at each time point (P >0.05) after adjusting for Week 0 values as a covariate. The simethicone group showed an average reduction in RV and GV of 10% and 21%, respectively, compared with the control group (P >0.05). Standard deviations were calculated over 10 time points, which were grouped to represent the first 2-3 weeks of radiation therapy versus subsequent weeks. These were not significantly different between the simethicone and control group. However, there was a statistically significant decrease in the variability of RV at time points 6-10 compared with time points 1-5 within the simethicone group (P = 0.012), but no significant difference was found between these grouped time points in the control group (P = 0.581). The toxicity questionnaires showed no significant difference between the groups. Conclusions: Simethicone did not decrease the RV or GV overall. However, simethicone appeared to significantly decrease the RV variability from Week three onwards. This suggests that taking simethicone two to three weeks before starting radiation therapy may reduce RV variability, although a larger study is needed to confirm this.

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Section: Discussioncontrasting

confidence: 67%

Randomised controlled trial on the effect of simethicone bowel preparation on rectal variability during image‐guided radiation therapy for prostate cancer (SPoRT study)

et al. 2022

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“…While some guidelines exist on use of daily image guidance, particularly for conventional fractionation, best practices and evidencebased guidelines are limited for other fractionation regimens [1]- [4]. Additionally, evidence to support a benefit from dietary and prescription interventions and patient instructions regarding bowel and bladder preparation is limited and inconsistent, making it challenging to synthesize the data into uniform recommendations [24]- [29]. Evidence supporting specific PTV margin expansions for various treatment modalities are available; however, individual radiation oncologists may tailor PTV margins in practice [30], [31].…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 Additionally, evidence to support a benefit from dietary and prescription interventions and patient instructions regarding bowel and bladder preparation is limited and inconsistent, making it challenging to synthesize the data into uniform recommendations. 24 , 25 , 26 , 27 , 28 , 29 Evidence supporting specific PTV margin expansions for various treatment modalities is available; however, individual radiation oncologists may tailor PTV margins in practice. 30 , 31 This survey was created to provide additional data on individual patterns of practice for different fractionation regimens to supplement the existing literature.…”

Section: Discussionmentioning

confidence: 99%

Bowel and Bladder Reproducibility in Image Guided Radiation Therapy for Prostate Cancer: Results of a Patterns of Practice Survey

Rowe

Mandia

Salerno

et al. 2022

Advances in Radiation Oncology

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“…A bladder and rectum protocol, as well as Foley catheters were omitted, because albeit side effects of these interventions are rare, we did not wish to expose the healthy volunteers to any risks. We acknowledge, that this might present a deviation from clinical practice; however, the clinical benefit of a bladder and rectum preparation protocol remains uncertain and has not been validated in randomized trials [ 30 , 31 ]. From an anatomical and dosimetric perspective, rectum filling and bladder filling do influence the doses delivered to these organs at risk.…”

Section: Discussionmentioning

confidence: 99%

Intrafractional stability of MR-guided online adaptive SBRT for prostate cancer

et al. 2021

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Background MR-guided online adaptive stereotactic body radiation therapy (SBRT) for prostate cancer aims to reduce toxicity by full compensation of interfractional uncertainties. However, the process of online adaptation currently takes approximately 45 min during which intrafractional movements remain unaccounted for. This study aims to analyze the dosimetric benefit of online adaptation and to evaluate its robustness over the duration of one treatment fraction. Methods Baseline MR-scans at a MR-linear accelerator were acquired for ten healthy male volunteers for generation of mock-prostate SBRT plans with a dose prescription of 5 × 7.25 Gy. On a separate day, online MR-guided adaptation (ViewRay® MRIdian) was performed, and thereafter MR images were acquired every 15 min for 1 h to assess the stability of the adapted plan. Results A dosimetric benefit of online MR-guided adaptive re-planning was observed in 90% of volunteers. The median D95CTV- and D95PTV-coverage was improved from 34.8 to 35.5 Gy and from 30.7 to 34.6 Gy, respectively. Improved target coverage was not associated with higher dose to the organs at risk, most importantly the rectum (median D1ccrectum baseline plan vs. adapted plan 33.3 Gy vs. 32.3 Gy). The benefit of online adaptation remained stable over 45 min for all volunteers. However, at 60 min, CTV-coverage was below a threshold of 32.5 Gy in 30% of volunteers (30.6 Gy, 32.0 Gy, 32.3 Gy). Conclusion The dosimetric benefit of MR-guided online adaptation for prostate SBRT was robust over 45 min in all volunteers. However, intrafractional uncertainties became dosimetrically relevant at 60 min and we therefore recommend verification imaging before delivery of MR-guided online adapted SBRT.

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To prep or not to prep - that is the question: A randomized trial on the use of antiflatulent medication as part of bowel preparation for patients having image guided external beam radiation therapy to the prostate

Cited by 7 publications

References 23 publications

Randomised controlled trial on the effect of simethicone bowel preparation on rectal variability during image‐guided radiation therapy for prostate cancer (SPoRT study)

Randomised controlled trial on the effect of simethicone bowel preparation on rectal variability during image‐guided radiation therapy for prostate cancer (SPoRT study)

Bowel and Bladder Reproducibility in Image Guided Radiation Therapy for Prostate Cancer: Results of a Patterns of Practice Survey

Intrafractional stability of MR-guided online adaptive SBRT for prostate cancer

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