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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. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396917000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAimsThe 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 methodsThe 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.ResultsReproducibility 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.FindingsThe 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.
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Evaluating the need for adaptive therapy when delivering conformal bladder radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2016. [DOI: 10.1017/s1460396915000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground and purposeThe purpose of this study was to audit positioning errors during bladder image-guided radiotherapy (IGRT) and quantify survival outcomes.Materials and methodsWe carried out a retrospective review of 141 patients treated between March 2007 and July 2010 with three-dimensional conformal radiotherapy. An offline imaging protocol using kV cone beam computed tomography (CBCT) was used. Positioning errors, clinical interventions and re-planning rates were quantified. Cancer outcomes and survival were collected by review of patient notes and a registry search.ResultsAmong all, 43% of the patients required no intervention. Isocentre corrections were used for systematic bony set-up error in 13% and to improve bladder coverage in 28%. Clinical interventions to improve bladder coverage were required in 16% of the patients and repeat computed tomography planning in a further 16%. Overall, 44% of the patients demonstrated some form of organ deformation that would have resulted in inadequate dose to the bladder or significant overdose to an organ at risk if not corrected for. Post-treatment check cystoscopy was undertaken in 107 patients (76%) with 72 noted to have a complete response. Overall survival was 47·8% at 3 years.ConclusionsOrgan deformation during radiotherapy for bladder cancer is a significant problem for over 40% of patients. Strategies to compensate are essential to ensure optimal plan delivery.
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