Successful use of tissue expander and pelvic sling to exclude small bowel for high-dose pelvic irradiation

2019 ◽  
Vol 34 (6) ◽  
pp. 1043-1046 ◽  
Author(s):  
Dedrick Kok Hong Chan ◽  
Timothy Cheo ◽  
Wai Kit Cheong
Keyword(s):  
Small Bowel ◽  
Tissue Expander ◽  
High Dose ◽  
Pelvic Irradiation ◽  
Pelvic Sling

scholarly journals Dosimetric Comparison between High Dose Rate Brachytherapy Boost and Volumetric Arc Therapy Boost in Locally Advanced Cancer Cervix

2021 ◽  
Vol 07 (02) ◽  
pp. 085-088
Author(s):  
Hanady Hegazy ◽  
Neamat Hegazy ◽  
Maher Soliman ◽  
Amr Elsaid
Keyword(s):  
Small Bowel ◽  
Dose Rate ◽  
Advanced Cancer ◽  
Locally Advanced ◽  
Target Volume ◽  
High Dose Rate ◽  
High Dose ◽  
Cancer Cervix ◽  
Arc Therapy ◽  
Locally Advanced Cancer

AbstractConcurrent chemoradiotherapy is considered the standard treatment for the locally advanced cancer cervix (LACC). Radiotherapy is commonly administered by a three-dimensional conformal radiotherapy (3DCRT) approach followed by brachytherapy (BT). High dose rate (HDR) BT is commonly administered; however, several drawbacks exist including invasive technique, pain, requirement of anesthesia, and operative risks. We assessed the dosimetric difference between the HDR BT and the volumetric modulated arc therapy (VMAT) boost in those patients. Ten patients were selected retrospectively with LACC and all received whole pelvis radiotherapy followed by BT boost of 7 Gy in three fractions. The computed tomography (CT) image was transferred to the Varian system for the VMAT plan while the one with the applicator was transferred to the Sagi planning system and the high-risk clinical target volume (HR-CTV), bladder, rectum, sigmoid, and small bowel were delineate with a margin of 5 mm were added to the CTV to create the planning target volume (PTV). The D90 for the PTV in VMAT boost was lower than received by the HR-CTV in the BT boost. Mean volume of the PTV was higher than that of the HR-CTV. The D2cc was higher in VMAT for bladder, sigmoid, and rectum while the D2cc for the small bowel in BT was higher compared with the VMAT. The VMAT is an option that exists for patients who refuse BT or cannot tolerate it, or in case of nonavailability of BT or a nonworking machine.

scholarly journals HDR brachytherapy and supervoltage external beam therapy of cervical cancer: Protection of the intestinal tract during the treatment

2002 ◽  
Vol 10 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Sasa Ljubenkovic
Keyword(s):  
Small Bowel ◽  
Standard Technique ◽  
Acute Radiation ◽  
Watery Diarrhoea ◽  
Radiation Enteritis ◽  
High Dose ◽  
Non Invasive ◽  
Dose Volume ◽  
Patient Table ◽  
One Year

BACKGROUND: During radiotherapy in most of the irradiated patients occur the symptoms of acute radiation enteritis, less frequently cystitis or proctitis. The aim of this work was to apply non invasive exclusion methods to reduce the small bowel volume within the pelvic high dose volume and indirectly to reduce the number and severity of acute radiation enteritis METHODS: A total number of 183 patients were enrolled in our prospective randomised investigation we performed at the Clinic of Oncology in Knez Selo during one year. Ninety patients from E-group were irradiated with the standard technique two opposite parallel fields on the Mevatron-7445 linear accelerator (SIEMENS) patient-table, while 93 from C-group were irradiated under special conditions on our unique patient-table (PT) manufactured at our special demands by the Jugorendgen Ei-Ni? factory Brachytherapy was administered with RALT technique in both groups with isotope machine BUCHLER. RESULTS: Individual application of exclusion techniques led to protection of over 50% of the small bowel (118-1065 cm3) in 30/43 (70%) patients, and even in 10/43 (23%) more than 90% of the small bowel was protected (118-835 cm3), which would otherwise be irradiated with conventional techniques. None of the patients from E-group (out of 90) had more than 8 stools a day (G3), while in C-group there were 20 such cases Seventy-seven percent of the patients from E-group had formed stool, while the percent in C-group was 29. In C-group 40% of the patients had so called "watery stools"; in E-group the percent was 4. Out of 53 patients from K-group with mobile small bowel, 21 (40%) had "watery diarrhoea". CONCLUSION: Measures to prevent radiation enteritis should be taken before (surgical) or during (non invasive) radiotherapy. At the Clinic of Oncology in Knez Selo, individual application of small bowel exclusion techniques using the unique patient-table (JUGORENDGEN Ei-Ni?) led to protection of the small bowel during radiotherapy of uterine malignancies, which was reflected in a significantly reduced number and severity of acute enteritis symptoms.

Effect of customized small bowel displacement system in pelvic irradiation

1998 ◽  
Vol 40 (3) ◽  
pp. 623-627 ◽  
Author(s):  
Seung Jae Huh ◽  
Do Hoon Lim ◽  
Yong Chan Ahn ◽  
Dae Yong Kim ◽  
Moon Kyung Kim ◽  
...  
Keyword(s):  
Small Bowel ◽  
Pelvic Irradiation ◽  
Displacement System

Relationship of acute gastrointestinal toxicity and the volume of irradiated small bowel in patients receiving combined modality therapy for rectal cancer.

1995 ◽  
Vol 13 (6) ◽  
pp. 1409-1416 ◽  
Author(s):  
B D Minsky ◽  
J A Conti ◽  
Y Huang ◽  
K Knopf
Keyword(s):  
Rectal Cancer ◽  
Small Bowel ◽  
Radiation Field ◽  
Combined Modality Therapy ◽  
High Dose ◽  
Pelvic Radiation ◽  
Postoperative Therapy ◽  
Combined Modality ◽  
Gi Toxicity ◽  
Experienced Grade

PURPOSE To determine the relationship between acute gastrointestinal (GI) toxicity during the combined modality segment and the volume of small bowel in the pelvic radiation field in patients who receive either preoperative or postoperative therapy for rectal cancer. PATIENTS AND METHODS The patient population was derived from four consecutive phase I dose-escalation trials. Combined modality therapy included fluorouracil (5-FU), leucovorin ([LV] bolus daily x 5, days 1 and 29), and pelvic radiation. RESULTS Twenty patients who received postoperative therapy had a larger volume of small bowel in the pelvic radiation field as compared with 60 who received preoperative therapy (462 +/- 129 v 212 +/- 44 cm3, P = .002). The most significant relationship between acute GI toxicity and volume of small bowel was seen in 12 patients who were treated on the preoperative sequential low-dose LV trial, all of whom received the maximum-tolerated dose (MTD) of 5-FU. The volume of small bowel in patients who experienced grade 3+ toxicity was 731 +/- 274 cm3, as compared with 145 +/- 58 in those who experienced grade 0 to 2 toxicity (P = .005). Likewise, logistic regression analysis showed that 26 patients who received the MTD of 5-FU had the most significant association between GI toxicity and volume of small bowel (P = .036). CONCLUSION Our data suggest that the volume of small bowel in the pelvic radiation field may be dose-limiting in the delivery of high-dose 5-FU when combined with LV and radiation therapy.

scholarly journals Clostridium difficileEnteritis after Total Abdominal Colectomy for Ulcerative Colitis

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Hassan Nasser ◽  
Semeret Munie ◽  
Dania Shakaroun ◽  
Tommy Ivanics ◽  
Surya Nalamati ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Small Bowel ◽  
Case Reports ◽  
Multiorgan Failure ◽  
Rare Condition ◽  
Nucleic Acid Amplification ◽  
Wall Thickening ◽  
Total Proctocolectomy ◽  
High Dose ◽  
Port Site Hernia

Introduction.IsolatedClostridium difficilesmall bowel enteritis is a rare condition with significant morbidity and mortality.Presentation of Case.An 83-year-old female with refractory ulcerative colitis underwent a total proctocolectomy and end ileostomy. Her postoperative course was complicated with return to the operating room for repair of an incarcerated port site hernia. Subsequently, she developed septic shock and multiorgan failure requiring intubation and mechanical ventilation, renal replacement therapy, and high dose vasopressors. Diagnostic workup revealed diffuse small bowel wall thickening on computed tomography scan as well as positive nucleic acid amplification test forC. difficiletoxin B gene. Despite treatment with antibiotics and maximum attempts at resuscitation, the patient expired.Discussion. C. difficileinfection most commonly affects the colon but rarely can involve the small bowel. The pathogenesis ofC. difficileenteritis is unclear but is believed to mirror that of colitis. Surgical patients are susceptible forC. difficileinfection, as they tend to be relatively immunosuppressed in the postoperative period. Radiologic findings of enteritis may mimic those of colitis and this includes small bowel dilation and thickening. Treatment for this condition has not been well established but it is approached similar to colitis.Conclusion.Despite an increase in the number of case reports ofC. difficileenteritis, it continues to be a rare but potentially fatal infection. Clinicians should maintain a high index of suspicion especially in patients with inflammatory bowel disease who undergo colon resections.

Bladder cancer following low or high dose pelvic irradiation

1987 ◽  
Vol 38 (6) ◽  
pp. 583-585 ◽  
Author(s):  
P.M. Quilty ◽  
G.R. Kerr
Keyword(s):  
Bladder Cancer ◽  
High Dose ◽  
Pelvic Irradiation
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