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Evaluation of a Belly Board immobilisation device for rectal cancer patients receiving pre-operative chemoradiation

Published online by Cambridge University Press:  11 August 2014

Andrew Gaya*
Affiliation:
Department of Clinical Oncology
Patryk Brulinski
Affiliation:
Department of Clinical Oncology
Stephen L. Morris
Affiliation:
Department of Clinical Oncology
Kim A. Ball
Affiliation:
Department of Radiotherapy
Anthony G. Greener
Affiliation:
Department of Medical Physics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Sue Corcoran
Affiliation:
Department of Medical Physics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Anthony Henrys
Affiliation:
Department of Radiotherapy
David B. Landau
Affiliation:
Department of Clinical Oncology
George Mikhaeel
Affiliation:
Department of Clinical Oncology
Martin D. Leslie
Affiliation:
Department of Clinical Oncology
Anna Z. Winship
Affiliation:
Department of Clinical Oncology
*
Correspondence to: Dr Andrew Gaya, Department of Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK. Tel: +44 (0) 20 7188 1459. Fax: +44 (0) 20 7009 4272. E-mail: [email protected]

Abstract

Purpose

To evaluate the efficacy of a Belly Board immobilisation device for rectal cancer patients.

Materials and methods

A randomised trial in patients receiving neo-adjuvant chemoradiation for rectal carcinoma was established. Patients were treated, prone with control arm, according to standard departmental protocol and experimental arm with the use of a Belly Board. All treatments were planned using a three-field technique. The primary endpoints were reproducibility and irradiated small bowel volume. Questionnaires were used to assess secondary endpoints of patient comfort, ease of set-up and acute toxicities.

Results

Pre-planned interim analysis was performed after recruiting 30 patients. In all, 348 portal images were analysed retrospectively. Around 8 out of 12 parameters measuring set-up reproducibility were in favour of the Belly Board arm. Random error in the anterior–posterior direction was improved and statistically significant in the experimental arm (95% CI; p≤0·05). Small bowel V15 was significantly lower in the Belly Board position (mean V15=14·5%) compared with the standard position (mean V15=21·4%), paired t-test 95% CI; p=0·035. Also, patients’ comfort satisfaction was greater in the Belly Board arm.

Conclusions

Set-up reproducibility, small bowel V15, patient comfort and satisfaction were all significantly improved by the use of the Belly Board.

Type
Original Articles
Copyright
© Cambridge University Press 2014 

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References

1. Krook, J E, Moertel, C G, Gunderson, L L et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991; 324: 709715.Google Scholar
2. MacFarlane, J K, Ryall, R D H, Heald, R J. Mesorectal excision for rectal cancer. Lancet 1993; 341: 457460.Google Scholar
3. Gallagher, M J, Brereton, H D, Rostock, R A et al. A prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic radiation. Int J Radiat Oncol Biol Phys 1986; 12: 15651573.CrossRefGoogle Scholar
4. Baglan, K L, Frazier, R C, Yan, D, Huang, R R, Martinez, A A, Robertson, J M. The dose-volume relationship of acute small bowel toxicity from concurrent 5-FU-based chemotherapy and radiation therapy for rectal cancer. Int J Radiat Oncol Biol Phys 2002; 52: 176183.Google Scholar
5. Emami, B, Lyman, J, Brown, A et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991; 21: 109122.CrossRefGoogle ScholarPubMed
6. Cole, H. Displacement of small bowel from pelvic radiation field. Lancet 1988; 2: 13411342.Google Scholar
7. Gunderson, L L, Russell, A H, Llewellyn, H J, Doppke, K P, Tepper, J E. Treatment planning for colorectal cancer: radiation and surgical techniques and value of small-bowel films. Int J Radiat Oncol Biol Phys 1985; 11: 13791393.Google Scholar
8. Das, I J, Lanciano, R M, Movsas, B, Kagawa, K, Barnes, S J. Efficacy of a belly board device with CT-simulation in reducing small bowel volume within pelvic irradiation fields. Int J Radiat Oncol Biol Phys 1997; 39: 6776.CrossRefGoogle ScholarPubMed
9. Shanahan, T G, Mehta, M P, Bertelrud, K L et al. Minimization of small bowel volume within treatment fields utilizing customized ‘belly boards’. Int J Radiat Oncol Biol Phys 1990; 19: 469476.Google Scholar
10. Huh, S J, Lim, D H, Ahn, Y C et al. Effect of customized small bowel displacement system in pelvic irradiation. Int J Radiat Oncol Biol Phys 1998; 40: 623627.CrossRefGoogle ScholarPubMed
11. Rudat, V, Flentje, M, Engenhart, R, Metzger, M, Wannenmacher, M. The belly-board technic for the sparing of the small intestine. Studies on positioning accuracy taking into consideration conformational irradiation technics. Strahlenther Onkol 1995; 171: 437443.Google Scholar
12. Olofsen-van Acht, M J, Quint, S, Seven, M et al. Three-dimensional treatment planning for postoperative radiotherapy in patients with node-positive cervical cancer. Comparison between a conventional and a conformal technique. Strahlenther Onkol 1999; 175: 462469.Google Scholar
13. Portelance, L, Chao, K S, Grigsby, P W, Bennet, H, Low, D. Intensity-modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. Int J Radiat Oncol Biol Phys 2001; 51: 261266.Google Scholar
14. Nijkamp, J, Doodeman, B, Marijnen, C, Vincent, A, van Vliet-Vroegindeweij, C. Bowel exposure in rectal cancer IMRT using prone, supine, or a belly board. Radiother Oncol 2012; 102: 2229.Google Scholar
15. Wiesendanger-Wittmer, E M, Sijtsema, N M, Muijs, C T, Beukema, J C. Systematic review of the role of a belly board device in radiotherapy delivery in patients with pelvic malignancies. Radiother Oncol 2012; 102 (3): 325334.CrossRefGoogle ScholarPubMed
16. Bidmead, M, Coffey, M, Crellin, A et al. Geometric Uncertainties in Radiotherapy: Defining the Target Volume. London, UK: British Institute of Radiology, 2003.Google Scholar
17. Morgan, S, Greener, A G. ImageTrack: A Software Tool for Analyzing and Refining Treatment Verification. Programme Abstract from ‘IMRT—A Clinical Service for the 21st Century’ Meeting. Manchester, UK: Institute of Physics in Engineering and Medicine, 2005.Google Scholar
18. Greener, A G. Practical Determination of Systematic and Random Set-Up Errors Using Portal Imaging. Geometric Uncertainties in Radiotherapy: Appendix 2c. London, UK: British Institute of Radiology, 2003.Google Scholar
19. Trotti, A, Colevas, A D, Setser, A et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 2003; 13: 176181.Google Scholar
20. Altman, D G. Statistics and ethics in medical research: III. How large a sample? Br Med J 1980; 281: 13361338.Google Scholar
21. Lee, S H, Kim, T H, Kim, D Y et al. The effect of belly board location in rectal cancer patients treated with preoperative radiotherapy. Clin Oncol (R Coll Radiol) 2006; 18: 441446.Google Scholar
22. Kim, T H, Chie, E K, Kim, D Y et al. Comparison of the belly board device method and the distended bladder method for reducing irradiated small bowel volumes in preoperative radiotherapy of rectal cancer patients. Int J Radiat Oncol Biol Phys 2005; 62: 769775.Google Scholar
23. Ghosh, K, Padilla, L A, Murray, K P, Downs, L S, Carson, L F, Dusenbery, K E. Using a belly board device to reduce the small bowel volume within pelvic radiation fields in women with postoperatively treated cervical carcinoma. Gynecol Oncol 2001; 83: 271275.CrossRefGoogle ScholarPubMed
24. Martin, J, Fitzpatrick, K, Horan, G et al. Treatment with a belly-board device significantly reduces the volume of small bowel irradiated and results in low acute toxicity in adjuvant radiotherapy for gynecologic cancer: results of a prospective study. Radiother Oncol 2005; 74: 267274.Google Scholar
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