High buttocks supine position to reduce small bowel exposure in gynecological radiotherapy.
Humans
Female
Intestine, Small
/ radiation effects
Supine Position
Radiotherapy, Intensity-Modulated
/ methods
Middle Aged
Genital Neoplasms, Female
/ radiotherapy
Buttocks
/ radiation effects
Adult
Organs at Risk
/ radiation effects
Aged
Patient Positioning
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
/ methods
Tomography, X-Ray Computed
Radiation Injuries
/ prevention & control
Gynecological tumor
High buttocks supine position
IMRT
Small bowel
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
27 Sep 2024
27 Sep 2024
Historique:
received:
25
06
2024
accepted:
10
09
2024
medline:
28
9
2024
pubmed:
28
9
2024
entrez:
28
9
2024
Statut:
epublish
Résumé
To minimize radiation exposure to the small bowel (SB) in patients undergoing treatment for gynecological tumors by adopting a comfortable positioning method. All 76 women undergoing Intensity-Modulated Radiation Therapy (IMRT) were included in this study. Patients were immobilized in a supine position using a vacuum bag and thermoplastic cast formation. In the trial group (n = 36), patients raised their buttocks and a solid foam pad was placed under the sacral tail before immobilization. The control group (n = 40) received treatment in the standard supine position. The SB was delineated from the pubic symphysis to the total iliac bifurcation in computed tomography (CT) scans. In the trial group, a significant reduction in SB volume within the pelvic cavity was observed (mean 399.17 ± 158.7 cc) compared to the control group (mean 547.48 ± 166.9 cc), with a p-value less than 0.001. The trial group showed a statistically significant reduction in the absolute volume of irradiated SB at each dose, ranging from the low dose (10 Gy) to the high dose (45 Gy). In the control group, a negative correlation was found between SB and bladder volumes (R = -0.411, P = 0.008), whereas in the trial group, this correlation was weaker (R = -0.286, P = 0.091), with no significant relationship observed between bladder volume and SB. The high buttocks supine position effectively reduces SB radiation exposure without the need for bladder distension. This positioning method holds promise for reducing SB irradiation in various pelvic tumors.
Identifiants
pubmed: 39334494
doi: 10.1186/s13014-024-02522-6
pii: 10.1186/s13014-024-02522-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
131Informations de copyright
© 2024. The Author(s).
Références
Letschert JG. The prevention of radiation-induced small bowel complications. Eur J cancer (Oxford England: 1990). 1995;31a(7–8):1361–5.
doi: 10.1016/0959-8049(95)00179-M
Kavanagh BD, Pan CC, Dawson LA, Das SK, Li XA, Ten Haken RK, et al. Radiation dose-volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S101–7.
doi: 10.1016/j.ijrobp.2009.05.071
pubmed: 20171503
Robertson JM, Lockman D, Yan D, Wallace M. The dose-volume relationship of small bowel irradiation and acute grade 3 diarrhea during chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2008;70(2):413–8.
doi: 10.1016/j.ijrobp.2007.06.066
pubmed: 17904305
Apetoh L, Ghiringhelli F, Tesniere A, Obeid M, Ortiz C, Criollo A, et al. Toll-like receptor 4-dependent contribution of the immune system to anticancer chemotherapy and radiotherapy. Nat Med. 2007;13(9):1050–9.
doi: 10.1038/nm1622
pubmed: 17704786
Jian Y, Zhang D, Liu M, Wang Y, Xu ZX. The impact of Gut Microbiota on Radiation-Induced Enteritis. Front Cell Infect Microbiol. 2021;11:586392.
doi: 10.3389/fcimb.2021.586392
pubmed: 34395308
pmcid: 8358303
Koeck J, Kromer K, Lohr F, Baack T, Siebenlist K, Mai S, et al. Small bowel protection in IMRT for rectal cancer: a dosimetric study on supine vs. prone position. Strahlenther Onkol. 2017;193(7):578–88.
doi: 10.1007/s00066-017-1107-z
pubmed: 28220185
Martin J, Fitzpatrick K, Horan G, McCloy R, Buckney S, O’Neill L, 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(3):267–74.
doi: 10.1016/j.radonc.2004.11.010
pubmed: 15763307
Kim TH, Chie EK, Kim DY, Park SY, Cho KH, Jung KH, 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(3):769–75.
doi: 10.1016/j.ijrobp.2004.11.015
pubmed: 15936558
Zelefsky MJ, Happersett L, Leibel SA, Burman CM, Schwartz L, Dicker AP, et al. The effect of treatment positioning on normal tissue dose in patients with prostate cancer treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 1997;37(1):13–9.
doi: 10.1016/S0360-3016(96)00460-9
pubmed: 9054872
Loo M, Martinez-Gomez C, Khalifa J, Angeles MA, Chira C, Piram L, et al. Laparoscopic closure of the pouch of Douglas by a peritoneal running suture. A minimally invasive and prosthetic-free technique to prevent excessive dose delivery to the small bowel during pelvic irradiation for prostate cancer. Clin Translational Radiation Oncol. 2021;26:71–8.
doi: 10.1016/j.ctro.2020.11.015
Frøseth TC, Strickert T, Solli KS, Salvesen Ø, Frykholm G, Reidunsdatter RJ. A randomized study of the effect of patient positioning on setup reproducibility and dose distribution to organs at risk in radiotherapy of rectal cancer patients. Radiation Oncol (London England). 2015;10:217.
doi: 10.1186/s13014-015-0524-3
Esmati E, Barzegartahamtan M, Maddah A, Alikhassi A, Vaezzadeh V, Mohammadpour R. The effect of patient positioning (prone or supine) on the dose received by small bowel in pelvic radiotherapy in rectal cancer patients. Cancer Radiotherapie: J De La Societe francaise de radiotherapie oncologique. 2021;25(5):419–23.
doi: 10.1016/j.canrad.2020.04.013
Allal AS, Bischof S, Nouet P. Impact of the belly board device on treatment reproducibility in preoperative radiotherapy for rectal cancer. Strahlenther Onkol. 2002;178(5):259–62.
doi: 10.1007/s00066-002-0889-8
pubmed: 12082685
Bayley AJ, Catton CN, Haycocks T, Kelly V, Alasti H, Bristow R, et al. A randomized trial of supine vs. prone positioning in patients undergoing escalated dose conformal radiotherapy for prostate cancer. Radiother Oncol. 2004;70(1):37–44.
doi: 10.1016/j.radonc.2003.08.007
pubmed: 15036850
Caspers RJ, Hop WC. Irradiation of true pelvis for bladder and prostatic carcinoma in supine, prone or Trendelenburg position. Int J Radiat Oncol Biol Phys. 1983;9(4):589–93.
doi: 10.1016/0360-3016(83)90081-0
pubmed: 6853261
Scobioala S, Kittel C, Niermann P, Wolters H, Susek KH, Haverkamp U, et al. A treatment planning study of prone vs. supine positions for locally advanced rectal carcinoma: comparison of 3–dimensional conformal radiotherapy, tomotherapy, volumetric modulated arc therapy, and intensity-modulated radiotherapy. Strahlentherapie Und Onkologie: Organ Der Deutschen Rontgengesellschaft [et al]. 2018;194(11):975–84.
doi: 10.1007/s00066-018-1324-0
Kim A, Karotki A, Presutti J, Gonzales G, Wong S, Chu W. The effect of prone and supine treatment positions for the pre-operative treatment of rectal cancer on organ-at-risk sparing and setup reproducibility using volumetric modulated arc therapy. Radiat Oncol. 2017;12(1):180.
doi: 10.1186/s13014-017-0918-5
pubmed: 29202879
pmcid: 5715653
Das IJ, Lanciano RM, Movsas B, Kagawa K, Barnes SJ. 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(1):67–76.
doi: 10.1016/S0360-3016(97)00310-6
pubmed: 9300741
Olofsen-van Acht M, van den Berg H, Quint S, de Boer H, Seven M, van Sömsen de Koste J, et al. Reduction of irradiated small bowel volume and accurate patient positioning by use of a bellyboard device in pelvic radiotherapy of gynecological cancer patients. Radiotherapy Oncology: J Eur Soc Therapeutic Radiol Oncol. 2001;59(1):87–93.
doi: 10.1016/S0167-8140(00)00279-6
Koelbl O, Richter S, Flentje M. Influence of patient positioning on dose-volume histogram and normal tissue complication probability for small bowel and bladder in patients receiving pelvic irradiation: a prospective study using a 3D planning system and a radiobiological model. Int J Radiat Oncol Biol Phys. 1999;45(5):1193–8.
doi: 10.1016/S0360-3016(99)00345-4
pubmed: 10613312
Weiss E, Richter S, Hess CF. Radiation therapy of the pelvic and paraaortic lymph nodes in cervical carcinoma: a prospective three-dimensional analysis of patient positioning and treatment technique. Radiotherapy Oncology: J Eur Soc Therapeutic Radiol Oncol. 2003;68(1):41–9.
doi: 10.1016/S0167-8140(03)00080-X
Lee SH, Kim TH, Kim DY, Cho KH, Kim JY, Park SY, et al. The effect of belly board location in rectal cancer patients treated with preoperative radiotherapy. Clin Oncol (R Coll Radiol). 2006;18(6):441–6.
doi: 10.1016/j.clon.2006.05.001
pubmed: 16909966
Stromberger C, Kom Y, Kawgan-Kagan M, Mensing T, Jahn U, Schneider A, et al. Intensity-modulated radiotherapy in patients with cervical cancer. An intra-individual comparison of prone and supine positioning. Radiat Oncol. 2010;5:63.
doi: 10.1186/1748-717X-5-63
pubmed: 20598136
pmcid: 2904783
Muren LP, Smaaland R, Dahl O. Organ motion, set-up variation and treatment margins in radical radiotherapy of urinary bladder cancer. Radiother Oncol. 2003;69(3):291–304.
doi: 10.1016/S0167-8140(03)00246-9
pubmed: 14644489
Kim TH, Kim DY, Cho KH, Kim YH, Jung KH, Ahn JB, et al. Comparative analysis of the effects of belly board and bladder distension in postoperative radiotherapy of rectal cancer patients. Strahlenther Onkol. 2005;181(9):601–5.
doi: 10.1007/s00066-005-1398-3
pubmed: 16170488