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A feasibility study for the introduction of micro-enema to improve organ consistency in patients receiving radiotherapy for urinary bladder cancer

Published online by Cambridge University Press:  20 June 2017

D. Hutton ,
J. Callender ,
N. Hutton ,
H. Wong  and
I. Syndikus
D. Hutton*
Affiliation:
The Clatterbridge Cancer Centre NHS FT, Wirral, UK
J. Callender
Affiliation:
The University of Liverpool, Liverpool, UK
N. Hutton
Affiliation:
The Clatterbridge Cancer Centre NHS FT, Wirral, UK
H. Wong
Affiliation:
The Clatterbridge Cancer Centre NHS FT, Wirral, UK
I. Syndikus
Affiliation:
The Clatterbridge Cancer Centre NHS FT, Wirral, UK
*
Correspondence to: Daniel Hutton, Transforming Cancer Care, Clatterbridge Centre for Oncology NHS Foundation Trust, Clatterbridge Road, Bebbington, Wirral, CH63 4JY, UK. Tel: 0151 556 5854. E-mail: [email protected]
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Abstract

Aims

The aim of the study was to assess the effect on rectal consistency, of introducing a micro-enema in the preparation of patients receiving radiotherapy treatment of urinary bladder cancer.

Materials and methods

The treatment cone beam computed tomography (CBCT) images from patients receiving radiotherapy for bladder cancer were retrospectively assessed. CBCT datasets from nine patients treated without rectal preparation (97 CBCT), and 13 patients (134 CBCT) treated following micro-enema use before planning and treatment were evaluated. CBCT were compared with the planning computed tomography for rectal status, rectal diameter and presence of gas.

Results

Reproducibility of an empty rectum was achieved in 70% of treatment fractions delivered using an enema protocol compared with 33% of fractions delivered without preparation. In total, 10% of fractions were delivered with the presence of faeces or faeces and gas, compared with 46% of fractions for the non-intervention group. Enemas did not affect the proportion of fractions delivered with gas, however, where gas was present, 65% of CBCT fractions had <5% gas for patients using enemas compared with 32% without.

Findings

The use of a micro-enema before planning scan and each fraction was well tolerated and proved effective in managing and reducing inter-fraction variations in rectal volume and contents.

Keywords

adaptivebladder cancerenemaradiotherapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 17 , Issue 1 , March 2018 , pp. 20 - 28
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Copyright
© Cambridge University Press 2017 

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References

1. Henry, A M, Stratford, J, McCarthy, C et al. X-ray volume imaging in bladder radiotherapy verification. Int J Radiat Oncol Biol Phys 2006; 64: 1174e8.CrossRefGoogle ScholarPubMed
2. Lutkenhaus, L, Visser, J, DeJong, R, Hulshof, M, Bel, A. Evaluation of delivered dose for a clinical daily adaptive plan selection strategy for bladder cancer radiotherapy. Radiother Oncol 2015; 116: 51–56.CrossRefGoogle ScholarPubMed
3. Pos, F, Remeijer, P. Adaptive management of bladder cancer radiotherapy. Radiat Oncol 2010; 20: 116–120.CrossRefGoogle ScholarPubMed
4. Fokdal, L, Honore, H, Hoyer, M, Meldgaard, P, Fode, K, VonDer Maase, H. Impact of changes in bladder and rectal filling volume on organ motion and dose distribution of the bladder in radiotherapy for urinary bladder cancer. Int J Radiat Oncol Biol Phys 2004; 59 (2): 436–444.CrossRefGoogle ScholarPubMed
5. Yee, D, Parliament, M, Rathee, S, Ghosh, S, Ko, L, Murray, B. Cone beam CT imaging analysis of interfractional variations in bladder volume and position during radiotherapy for bladder cancer. Int J Radiat Oncol Biol Phys 2010; 76 (4): 1045–1053.CrossRefGoogle ScholarPubMed
6. Pos, F, Koedooder, K, Hulshof, M, Van Tienhoven, G, Gonzalez, D. Influence of bladder and rectal volume on spatial variability of a bladder tumor during radical radiotherapy. Int J Radiat Oncol Biol Phys 2003; 55 (3): 835–841.CrossRefGoogle ScholarPubMed
7. Foroudi, F, Wong, J, Haworth, A et al. Offline adaptive radiotherapy for bladder cancer using cone beam computed tomography. J Med Imaging Radiat Oncol 2009; 53: 226–233.CrossRefGoogle ScholarPubMed
8. Thariat, J, Aluwini, S, Pan, Q et al. Image-guided radiation therapy for muscle-invasive bladder cancer. Nat Rev Urol 2012; 9: 23–29.CrossRefGoogle Scholar
9.National Radiotherapy Implementation Group Report. Image Guided Radiotherapy (IGRT) Guidance for implementation and use, 2012. https://www.sor.org/sites/default/files/document-versions/National%20Radiotherapy%20Implementation%20Group%20Report%20IGRT%20Final.pdf Accessed on 12th February 2017.Google Scholar
10. Tuomikoski, L, Collan, J, Keyrilainen, J, Visapaa, H, Saarilahti, K, Tenhunen, M. Adaptive radiotherapy in muscle invasive urinary bladder cancer – an effective method to reduce the irradiated bowel volume. Radiother Oncol 2011; 99: 61–66.CrossRefGoogle ScholarPubMed
11. Hutton, D, Leadbetter, J, Jain, P, Baker, A. Does one size fit all? Adaptive radiotherapy for bladder cancer: a feasibility study. Radiography 2012; 19: 1–6.Google Scholar
12. Yan, D, Lockman, D, Brabbins, D et al. An off-line strategy for constructing a patient specific target volume for adaptive treatment process for prostate cancer. Int J Radiat Oncol Biol Phys 2000; 48: 289–e302.CrossRefGoogle ScholarPubMed
13. Kron, T, Wong, J, Rolfo, A, Pham, D, Cramb, J, Foroudi, F. Adaptive radiotherapy for bladder cancer reduces integral dose despite daily volumetric imaging. Radiother Oncol 2010; 97: 485–487.CrossRefGoogle ScholarPubMed
14. Lalondrelle, S, Huddart, R, Warren-Oseni, K et al. Adaptive-predictive organ localization using cone-beam computed tomography for improved accuracy in external beam radiotherapy for bladder cancer. Int J Radiat Oncol Biol Phys 2011; 79 (3): 705e12.CrossRefGoogle ScholarPubMed
15. Bolart Trial. http://www.trog.com.au/TROG-1001-BOLART. Accessed on 12th February 2017.Google Scholar
16. Hybrid Trial. http://www.icr.ac.uk/our-research/our-research-centres/clinical-trials-and-statistics-unit/clinical-trials/hybrid. Accessed on 12th February 2017.Google Scholar
17. Raider Trial. http://www.icr.ac.uk/our-research/our-research-centres/clinical-trials-and-statistics-unit/clinical-trials/raider. Accessed on 12th February 2017.Google Scholar
18. Fouroudi, F, Wong, J, Kron, T et al. Online asaptive radiotherapy for muscle-invasive bladder cancer: results of a pilot study. Int J Radiat Oncol Biol Phys 2011; 81 (3): 765–771.CrossRefGoogle Scholar
19. Lotz, H, Pos, F, Hulshof, C et al. Tumor motion and deformation during external radiotherapy of bladder cancer. Int J Radiat Oncol Biol Phys 2006; 64 (5): 1551–1558.CrossRefGoogle ScholarPubMed
20. Hutton, D, Callender, J, Baker, A. The introduction of patient preparation to facilitate IGRT and ART for bladder radiotherapy. SCoR Radiotherapy Conference, Bristol, 2014.Google Scholar
21. Lotz, H, van Herk, M, Betgen, A, Pos, F, Lebesque, J, Remeijer, P. Reproducibility of the bladder shape and bladder shape changes during filling. Med Phys 2005; 32 (8): 2590–2597.CrossRefGoogle ScholarPubMed
22. Pickett, B, Roach, M 3rd, Verhey, L et al. The value of non-uniform margins for six-field conformal irradiation of localized prostate cancer. Int J Radiat Oncol Biol Phys 1995; 32: 211–218.CrossRefGoogle Scholar
23. Stroom, JC, Koper, PC, Korevaar, GA et al. Internal organ motion in prostate cancer patients treated in prone and supine treatment position. Radiother Oncol 1999; 51: 237–248.CrossRefGoogle ScholarPubMed
24. Zelefsky, MJ, Crean, D, Mageras, GS et al. Quantification and predictors of prostate position variability in 50 patients evaluated with multiple CT scans during conformal radiotherapy. Radiother Oncol 1999; 50: 225–234.CrossRefGoogle ScholarPubMed
25. Smitsmans, M, Pos, F, De Bois, J et al. The influence of a dietary protocol on cone beam CT-guided radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2008; 71 (4): 1279–1286.CrossRefGoogle ScholarPubMed
26. Yaver, M, Foo, A, Larsen, T et al. Consistency of organ geometries during prostate radiotherapy with two different bladder and bowel regimes. J Med Imag Radiat Sci 2015; 46: 380–387.CrossRefGoogle Scholar
27. McNair, H, Wedlake, L, McVey, G, Thomas, K, Andreyev, J. Can diet combined with treatment scheduling achieve consistency of rectal filling in patients receiving radiotherapy to the prostate? Radiother Oncol 2011; 101: 471–478.CrossRefGoogle ScholarPubMed
28. Lips, I, Kotte, A, van Gils, C, van Leerdam, M, van der Heide, U, Vulpen, M. Influence of antiflatulent dietary advice on intrafraction motion for prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81 (4): e401–e406.CrossRefGoogle ScholarPubMed
29. Hutton, D, Blair, D, Baker, A, Callender, J. Evaluating the role of a micro-enema to reduce rectal volume variation and gas during radiotherapy for bladder cancer, European Society Radiation Oncology, Barcelona, 2015.CrossRefGoogle Scholar