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Overview of patient preparation strategies to manage internal organ motion during radiotherapy in the pelvis

Published online by Cambridge University Press:  23 July 2019

F. Slevin Open the ORCID record for F. Slevin [Opens in a new window] ,
M. Beasley ,
R. Speight ,
J. Lilley ,
L. Murray  and
A. Henry
F. Slevin*
Affiliation:
Leeds Cancer Centre, Leeds, UK University of Leeds, Leeds, UK
M. Beasley
Affiliation:
Leeds Cancer Centre, Leeds, UK
R. Speight
Affiliation:
Leeds Cancer Centre, Leeds, UK
J. Lilley
Affiliation:
Leeds Cancer Centre, Leeds, UK
L. Murray
Affiliation:
Leeds Cancer Centre, Leeds, UK University of Leeds, Leeds, UK
A. Henry
Affiliation:
Leeds Cancer Centre, Leeds, UK University of Leeds, Leeds, UK
*
Author for correspondence: F. Slevin, Leeds Cancer Centre, St James’s University Hospital, Leeds LS9 7TF, UK. Tel: +44 (0) 113 206 7685. Fax: +44 (0) 113 206 7871. E-mail: [email protected]
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Abstract

Introduction:

Pelvic internal organs change in volume and position during radiotherapy. This may compromise the efficacy of treatment or worsen its toxicity. There may be limitations to fully correcting these changes using online image guidance; therefore, effective and consistent patient preparation and positioning remain important. This review aims to provide an overview of the extent of pelvic organ motion and strategies to manage this motion.

Methods and Materials:

Given the breadth of this topic, a systematic review was not undertaken. Instead, existing systematic reviews and individual high-quality studies addressing strategies to manage pelvic organ motion have been discussed. Suggested levels of evidence and grades of recommendation for each strategy have been applied.

Results:

Various strategies to manage rectal changes have been investigated including diet and laxatives, enemas and rectal emptying tubes and rectal displacement with endorectal balloons (ERBs) and rectal spacers. Bladder-filling protocols and bladder ultrasound have been used to try to standardise bladder volume. Positioning the patient supine, using a full bladder and positioning prone with or without a belly board, has been examined in an attempt to reduce the volume of irradiated small bowel. Some randomised trials have been performed, with evidence to support the use of ERBs, rectal spacers, bladder-filling protocols and the supine over prone position in prostate radiotherapy. However, there was a lack of consistent high-quality evidence that would be applicable to different disease sites within the pelvis. Many studies included small numbers of patients were non-randomised, used less conformal radiotherapy techniques or did not report clinical outcomes such as toxicity.

Conclusions:

There is uncertainty as to the clinical benefit of many of the commonly adopted interventions to minimise pelvic organ motion. Given this and the limitations in online image guidance compensation, further investigation of adaptive radiotherapy strategies is required.

Keywords

bladder fillingorgan motionpelvisradiotherapyrectal emptying
Type
Literature Review
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 2 , June 2020 , pp. 182 - 189
Copyright
© Cambridge University Press 2019

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