Small Bowel Dose Parameters Predicting Grade ≥3 Acute Toxicity in Rectal Cancer Patients Treated With Neoadjuvant Chemoradiation: An Independent Validation Study Comparing Peritoneal Space Versus Small Bowel Loop Contouring Techniques

2013 ◽  
Vol 85 (5) ◽  
pp. 1225-1231 ◽  
Author(s):  
Robyn Banerjee ◽  
Santam Chakraborty ◽  
Ian Nygren ◽  
Richie Sinha
Keyword(s):  
Rectal Cancer ◽  
Small Bowel ◽  
Acute Toxicity ◽  
Space Versus ◽  
Neoadjuvant Chemoradiation ◽  
Bowel Loop ◽  
Small Bowel Loop ◽  
Independent Validation ◽  
Peritoneal Space ◽  
Grade 3

Predicting acute small-bowel toxicity in patients with rectal cancer treated with neoadjuvant chemoradiation: A comparison of peritoneal space versus small-bowel loop contouring techniques.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 673-673
Author(s):  
Robyn Banerjee ◽  
Santam Chakraborty ◽  
Ian Nygren ◽  
Richie Sinha
Keyword(s):  
Rectal Cancer ◽  
Logistic Regression ◽  
Small Bowel ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Characteristic Analysis ◽  
Dose Volume ◽  
Peritoneal Space ◽  
Grade 3

673 Background: In lieu of contouring individual small bowel loops, the peritoneal space (PS) has been suggested as a possible surrogate volume for predicting small bowel toxicity. A dose-volume relationship for the PS has not been firmly established. The aim of this study was to determine whether contours of the PS better predict significant acute small bowel toxicity in neoadjuvant rectal cancer patients when compared with contours of individual small bowel loops. Methods: A standardized contouring method was developed for the PS and retrospectively applied to the radiation treatment plans of sixty-seven patients treated with neoadjuvant chemoradiotherapy for rectal cancer. All patients had locally advanced disease, no evidence of metastases, and received concurrent radiation and infusional 5-Fluorourocil chemotherapy. Dose-volume histogram (DVH) data was extracted and analyzed against patient toxicity. Receiver operating characteristic analysis and logistic regression was carried out for both contouring methods. Results: Grade ≥ 3 small bowel toxicity occurred in 16% (11/67) of patients. Volumes of the contoured small bowel loops correlated with grade ≥ 3 toxicity at each 5 Gray (Gy) dose level from 5 to 45 Gy, with the greatest area under the curve (AUC) measuring .964 (p=.000) associated with the volume receiving at least 25 Gy (V25). Volumes of the contoured PS predicted toxicity from 5 to 40 Gy, with the greatest AUC also at the V25 and measuring .896 (p=.000). Logistic regression analysis demonstrated a less than 15% risk of acute grade ≥ 3 toxicity was associated with a V25 of 215 cc for the small bowel and 710 cc for the PS. Conclusions: DVH analysis of peritoneal space volumes predicts grade ≥ 3 small bowel toxicity in neoadjuvant rectal cancer patients, suggesting the peritoneal space is a reasonable surrogate for contouring individual small bowel loops. However, contouring individual small bowel loops is a more sensitive method for predicting toxicity at each dose increment. For both contouring methods, the greatest sensitivity for predicting toxicity was associated with the volume receiving at least 25 Gy (V25).

scholarly journals Intestinal obstruction due to small bowel herniation through foramen of Winslow: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
P. K. B. S. C. Bandara ◽  
A. M. Viraj Rohana ◽  
Aloka Pathirana
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Intestinal Obstruction ◽  
Reflux Disease ◽  
Bowel Loop ◽  
Internal Herniation ◽  
Small Bowel Loop ◽  
Foramen Of Winslow

Abstract Background Intestinal obstruction due to internal herniation of the bowel is a rare clinical entity which is often overlooked in the differential diagnosis of patients with abdominal pain who have no previous history of abdominal surgery. Several sites of bowel internal herniation have been described, amongst which internal herniation through the foramen of Winslow accounts for about 8% of cases. These patients present with nonspecific abdominal pain associated with symptoms of gastroesophageal reflux disease, and hence the diagnosis is often overlooked. The usual symptoms of intestinal obstruction can be delayed, which results in a delay in diagnosis and gangrene of the herniated bowel segment. Abdominal radiographs and computed tomography are helpful in the diagnosis. Open reduction is the management of choice; however, laparoscopic reduction has also been attempted, with good results. Case presentation We report a case of a middle-aged Sri Lankan man who presented with features of gastroesophageal reflux disease, developed features of intestinal obstruction and was found to have a gangrenous small bowel loop which had herniated through the foramen of Winslow. Following needle aspiration and reduction of the herniated small bowel loop, the gangrenous part of the small bowel was resected and an ileoileal anastomosis performed. The large foramen of Winslow was partially closed with interrupted stitches. The patient made an uneventful recovery. Conclusion Since delayed diagnosis of bowel obstruction is detrimental, it is of utmost importance to diagnose it early. Because internal herniation of the small bowel through the foramen of Winslow presents with nonspecific symptoms including features of gastroesophageal reflux disease, as documented in several cases worldwide and also presented by our patient, there should be a high degree of suspicion of internal herniation of the bowel causing bowel obstruction and low threshold for extensive investigation of patients presenting with symptoms of gastroesophageal reflux disease which does not resolve with usual medication.

scholarly journals Recurrent Intestinal Obstruction after Radiation Therapy: A Case Report and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
James Nguyen ◽  
Amani Jambhekar ◽  
Ziyad Nasrawi ◽  
Prasad Gudavalli
Keyword(s):  
Rectal Cancer ◽  
Case Report ◽  
Small Bowel ◽  
Intestinal Obstruction ◽  
Loop Ileostomy ◽  
Neoadjuvant Chemoradiation ◽  
Ileocolic Anastomosis ◽  
Neoadjuvant Radiotherapy ◽  
Diverting Loop Ileostomy ◽  
Radiation Induced

Introduction. In patients who have undergone resection for rectal cancer after neoadjuvant radiotherapy, loop ileostomy is commonly performed with few serious complications. In rare cases, if this irradiated small bowel is strictured, reversal of the affected ileostomy can have dire consequences. We present a case of a 62-year-old male with recurrent intestinal obstruction after closure of his loop ileostomy. Case Report. RC is a 62-year-old male who initially presented with rectal cancer and underwent neoadjuvant chemoradiation prior to a laparoscopic low anterior resection with diverting loop ileostomy. He underwent elective reversal of his ileostomy and developed persistent postoperative obstruction. He underwent resection of the prior reversal site with normal-appearing dilated proximal bowel loops and collapsed distal bowel loops. He again developed an obstructive picture and underwent resection of the prior anastomosis with creation of an ileocolic anastomosis, after which he recovered well postoperatively. Conclusion. In patients who receive radiation adjuvant therapy for colon cancer, radiation-induced stricture should be considered as a cause of small bowel obstruction postoperative. In the setting of a longstanding ileostomy, evaluation of a defunctionalized distal ileum may be necessary to evaluate potential obstruction from radiation changes.

scholarly journals Gastric remnant perforation due to trocar site herniation after laparoscopic Roux-en-Y gastric bypass

2019 ◽  
Vol 101 (3) ◽  
pp. e88-e90
Author(s):  
R Ebrahimi ◽  
M Kermansaravi ◽  
F Eghbali ◽  
A Pazouki
Keyword(s):  
Gastric Bypass ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Diagnostic Laparoscopy ◽  
Gastric Remnant ◽  
Bowel Loop ◽  
Low Grade ◽  
Small Bowel Loop ◽  
Trocar Site

A 39-year-old woman was admitted with colicky left upper-quadrant pain, dyspnoea, low-grade fever, tachycardia and a subtle left upper-quadrant tenderness without leucocytosis. Computed tomography revealed a distended gastric remnant due to small-bowel loop herniation at the trocar site. The patient underwent a diagnostic laparoscopy as her general condition worsened. Perforation across the staple line was seen and repaired. The postoperative period was uneventful. As a rare complication of laparoscopic Roux-en-Y gastric bypass, small-bowel obstruction is of great importance because it can lead to gastric remnant perforation if not managed correctly. There have been rare reports of trocar site herniation as a cause of small-bowel obstruction following laparoscopic Roux-en-Y gastric bypass. Prompt diagnostic laparoscopy should be considered. This is the first case reported in which the excluded stomach was perforated due to trocar site herniation of the small-bowel loop. It should be noted that the tissue around the perforation is fragile and proper tension should be employed when it is repaired. Generally, an omental patch is not encouraged.

Combined modality therapy of rectal cancer: decreased acute toxicity with the preoperative approach.

1992 ◽  
Vol 10 (8) ◽  
pp. 1218-1224 ◽  
Author(s):  
B D Minsky ◽  
A M Cohen ◽  
N Kemeny ◽  
W E Enker ◽  
D P Kelsen ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Acute Toxicity ◽  
Randomized Trials ◽  
Combined Modality Therapy ◽  
High Dose ◽  
Phase I Trials ◽  
Postoperative Therapy ◽  
Combined Modality ◽  
High Incidence ◽  
Grade 3

PURPOSE We compared the combined radiation therapy (RT) plus chemotherapy segments of two separate parallel phase I trials to determine if combined pelvic RT, fluorouracil (5-FU), and high-dose leucovorin (LV) had less acute toxicity when delivered preoperatively versus postoperatively in patients with rectal cancer. PATIENTS AND METHODS Patients with unresectable disease received preoperative RT plus LV and 5-FU followed by surgery and postoperative LV and 5-FU. Patients with resectable disease received identical doses, techniques, and schedules of RT and LV and 5-FU except all therapy was delivered postoperatively. On day 1, patients received LV and 5-FU times one cycle. RT began on day 8. A second cycle of LV and 5-FU was given concurrently with the fourth week of RT. RESULTS Although more patients (75% v 32%; P = .02) received the higher dose level of 5-FU (250 mg/m2), significantly fewer experienced acute grade 3 to 4 toxicity with preoperative versus postoperative therapy (13% v 48%; P = .045). There was no grade 3 to 4 myelosuppression in either group. The two grade 3 toxicities in the preoperative group were gastrointestinal. The grade 3 toxicities in the postoperative group included seven gastrointestinal and two genitourinary; four patients had a grade 4 toxicity. CONCLUSION Given the high incidence of grade 3 to 4 toxicity also reported in the postoperative combined modality adjuvant randomized trials, future adjuvant trials should explore the preoperative approach.

scholarly journals Evaluation of Small Bowel Motion and Feasibility of using the Peritoneal Space to Replace Bowel Loops for Dose Constraints during Intensity-Modulated Radiotherapy for Rectal Cancer

2020 ◽  
Author(s):  
Siyuan Li ◽  
Yanping Gong ◽  
Yongqiang Yang ◽  
Qi Guo ◽  
Jianjun Qian ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Small Bowel ◽  
Supine Position ◽  
Intensity Modulated Radiotherapy ◽  
Ct Scans ◽  
Intensity Modulated ◽  
Dose Volume ◽  
Dose Constraint ◽  
Bowel Motion ◽  
Peritoneal Space

Abstract Background The goal of this study was to assess small bowel motion and explore the feasibility of using peritoneal space (PS) to replace bowel loops (BL) via the dose constraint method to spare the small bowel during intensity-modulated radiotherapy (IMRT) for rectal cancer. Methods A total of 24 patients with rectal cancer who underwent adjuvant radiotherapy were selected. Weekly repeat CT scans from pre-treatment to the fourth week of treatment were acquired and defined as Plan, 1W, 2W, 3W, and 4W. BL and PS contours were delineated in all of the scans. Two IMRT plans called P PS and P BL were designed on Plan CT using two dose PS and BL constraint methods, respectively, and then copied to CT 1~4W. The shift%, dose volume, and NTCP of the small bowel in P PS and P BL during treatment were evaluated. Results Overall, 109 sets of CT scans from 24 patients were acquired, and 218 plans were designed and copied. The PS and BL volumes were 1339.28 cc and 250.27 cc. The BL and PS shift% V 15 was 28.48% and 11.79% ( p =0.000), which was less in the prone position than in the supine position (25.24% vs 32.10%, p =0.000; 9.9% vs 14.85%, p =0.000). On all of the CT scans, most P PS small bowel dose volumes were less than from P BL . V 15 was 170.07 cc vs 178.58 cc ( p =0.000), and they had a significant correlation. The NTCP of chronic and acute side effects from P PS was significantly less than P BL (2.80% vs 3.00%, p =0.018; 57.32% vs 58.64%, p =0.000). Conclusions This study indicated that small bowel motion may lead to uncertainties in its dose volume and NTCP evaluation during IMRT for rectal cancer. The BL movements were significantly greater than PS, and the prone position was significantly less than the supine position. Using PS instead of BL can spare the small bowel. V 15 <830 cc is the dose constraint standard.

scholarly journals Evaluation of Small Bowel Motion and Feasibility of using the Peritoneal Space to Replace Bowel Loops for Dose Constraints during Intensity-Modulated Radiotherapy for Rectal Cancer

2020 ◽  
Author(s):  
Siyuan Li ◽  
Yanping Gong ◽  
Yongqiang Yang ◽  
Qi Guo ◽  
Jianjun Qian ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Small Bowel ◽  
Supine Position ◽  
Intensity Modulated Radiotherapy ◽  
Ct Scans ◽  
Intensity Modulated ◽  
Dose Volume ◽  
Dose Constraint ◽  
Bowel Motion ◽  
Peritoneal Space

Abstract Background The goal of this study was to assess small bowel motion and explore the feasibility of using peritoneal space (PS) to replace bowel loops (BL) via the dose constraint method to spare the small bowel during intensity-modulated radiotherapy (IMRT) for rectal cancer. Methods A total of 24 patients with rectal cancer who underwent adjuvant radiotherapy were selected. Weekly repeat CT scans from pre-treatment to the fourth week of treatment were acquired and defined as Plan, 1W, 2W, 3W, and 4W. BL and PS contours were delineated in all of the scans. Two IMRT plans called PPS and PBL were designed on Plan CT using two dose PS and BL constraint methods, respectively, and then copied to CT 1 ~ 4W. The shift%, dose volume, and NTCP of the small bowel in PPS and PBL during treatment were evaluated. Results Overall, 109 sets of CT scans from 24 patients were acquired, and 218 plans were designed and copied. The PS and BL volumes were 1339.28 cc and 250.27 cc. The BL and PS shift% V15 was 28.48% and 11.79% (p = 0.000), which was less in the prone position than in the supine position (25.24% vs 32.10%, p = 0.000; 9.9% vs 14.85%, p = 0.000). On all of the CT scans, most PPS small bowel dose volumes were less than from PBL. V15 was 170.07 cc vs 178.58 cc (p = 0.000), and they had a significant correlation. The NTCP of chronic and acute side effects from PPS was significantly less than PBL (2.80% vs 3.00%, p = 0.018; 57.32% vs 58.64%, p = 0.000). Conclusions This study indicated that small bowel motion may lead to uncertainties in its dose volume and NTCP evaluation during IMRT for rectal cancer. The BL movements were significantly greater than PS, and the prone position was significantly less than the supine position. Using PS instead of BL can spare the small bowel. V15 < 830 cc is the dose constraint standard.

Sign in / Sign up

Export Citation Format

Share Document