Increased rectal wall stiffness after prostate radiotherapy: relation with fecal urgency

2012 ◽  
Vol 24 (4) ◽  
pp. 339-e166 ◽  
Author(s):  
R. Krol ◽  
W. P. M. Hopman ◽  
R. J. Smeenk ◽  
E. N. J. T. Van Lin
Keyword(s):  
Rectal Wall ◽  
Prostate Radiotherapy ◽  
Wall Stiffness ◽  
Fecal Urgency

scholarly journals Interdisciplinary consensus statement on indication and application of a hydrogel spacer for prostate radiotherapy based on experience in more than 250 patients

2016 ◽  
Vol 50 (3) ◽  
pp. 329-336 ◽  
Author(s):  
Arndt-Christian Müller ◽  
Johannes Mischinger ◽  
Theodor Klotz ◽  
Bernd Gagel ◽  
Gregor Habl ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Rectal Wall ◽  
Locally Advanced ◽  
Transrectal Ultrasound ◽  
Serious Adverse Event ◽  
Prostate Radiotherapy ◽  
Risk Prostate Cancer ◽  
Potential Benefits ◽  
Potential Risks ◽  
Current Experience

Abstract Background The aim of the study was to reach a consensus on indication and application of a hydrogel spacer based on multicentre experience and give new users important information to shorten the learning curve for this innovative technique. Methods The interdisciplinary meeting was attended by radiation oncologists and urologists, each with experience of 23 – 138 hydrogel injections (SpaceOAR®) in prostate cancer patients before dose-escalated radiotherapy. User experience was discussed and questions were defined to comprise practical information relevant for successful hydrogel injection and treatment. Answers to the defined key questions were generated. Hydrogel-associated side effects were collected to estimate the percentage, treatment and prognosis of potential risks. Results The main indication for hydrogel application was dose-escalated radiotherapy for histologically confirmed low or intermediate risk prostate cancer. It was not recommended in locally advanced prostate cancer. The injection or implantation was performed under transrectal ultrasound guidance via the transperineal approach after prior hydrodissection. The rate of injection-related G2-toxicity was 2% (n = 5) in a total of 258 hydrogel applications. The most frequent complication (n = 4) was rectal wall penetration, diagnosed at different intervals after hydrogel injection and treated conservatively. Conclusions A consensus was reached on the application of a hydrogel spacer. Current experience demonstrated feasibility, which could promote initiation of this method in more centres to reduce radiation-related gastrointestinal toxicity of dose-escalated IGRT. However, a very low rate of a potential serious adverse event could not be excluded. Therefore, the application should carefully be discussed with the patient and be balanced against potential benefits.

scholarly journals Compliance and capacity of the normal human rectum: Physical considerations and measurement Pitfalls

2007 ◽  
Vol 54 (2) ◽  
pp. 49-57 ◽  
Author(s):  
A.P. Zbar
Keyword(s):  
Rectal Wall ◽  
Biological Properties ◽  
Impedance Planimetry ◽  
Organ Deformation ◽  
Wall Stiffness ◽  
Hollow Organ ◽  
Normal Human ◽  
Human Rectum ◽  
Volume Characteristics

The assessment of parameters which adequately represent rectal and neorectal compliance is complex. Biological properties of the rectum during distension and relaxation show significant departures from in vitro physical compliance measurements; as much dependent upon the viscoelastic characteristics of hollow organ deformation as upon the technique of compliance calculation. This review discusses the pressure/volume characteristics of importance in the rectum during distension from a bioengineering perspective and outlines the disparities of such measurements in living biological systems. Techniques and pitfalls of newer methods to assess rectal wall stiffness (impedance planimetry and barostat measurement) are discussed. .

scholarly journals In vivoreal-time rectal wall dosimetry for prostate radiotherapy

2010 ◽  
Vol 55 (13) ◽  
pp. 3859-3871 ◽  
Author(s):  
Nicholas Hardcastle ◽  
Dean L Cutajar ◽  
Peter E Metcalfe ◽  
Michael L F Lerch ◽  
Vladimir L Perevertaylo ◽  
...  
Keyword(s):  
Rectal Wall ◽  
Prostate Radiotherapy

Evaluation of the clinical advantage of endo-rectal balloons (ERBs) for prostate treatments.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 148-148
Author(s):  
Sarah J Barton ◽  
Julia Stratford ◽  
Douglas Brand ◽  
Catherine Thompson ◽  
Cathy Taylor ◽  
...  
Keyword(s):  
Rectal Wall ◽  
Cone Beam Ct ◽  
Similarity Score ◽  
Positional Error ◽  
Treatment Unit ◽  
Prostate Radiotherapy ◽  
Positional Analysis ◽  
Mechanical Methods ◽  
Clinical Advantage

148 Background: The challenge of prostate and rectal motion during radiotherapy has been firmly established, both these problems are exacerbated by rectal instability. A number of different mechanical methods have been explored to see if the rectum can be stabilised. This study aimed to establish whether there is a clinical advantage in the use of ERB’s for the treatment of prostate patients, assessing inter-fractional prostate stability and dose to the rectum. Methods: This planning study was based on 10 patients with 2 sets of CT and Cone beam CT (CBCT) data with and without an ERB in situ. The ERB was a 100cc air filled RectalPro balloon. CBCT scan with and without the ERB were taken on the same day. The scans were contoured and planned using pinnacle version 9.8 with rotational arc therapy to a dose of 60Gy in 20 fractions, for an Elekta Agility treatment unit. An assumption was made that the prostate stability was directly related to the rectal stability. Based on this assumption, comparisons of the rectal position and dose on the CBCT verses the respective CBCT were made. The rectal DVH on the plans for the ERB verses no ERB were compared and a two-tailed T-test was used for statistical analysis of all comparisons. Results: Positional analysis demonstrated 12% improvement in the dice coefficient similarity score of the rectum for the ERB (P=0.0003). This only correlated to a significant improvement in the AP movement at mid prostate for the ERBs (P=0.031). The ERB position was seen to be influenced by the angle of insertion. Removal of the CBCT data from the 4 ERBs with largest deviations in insertion angle significantly reduced the inter-fractional movement seen with the ERBs. The lower rectal doses showed an improvement of around 8% for the ERB group, although for the 57Gy dose was 2.5% better with no-ERB as shown in the Table. Conclusions: There is a clinical and statistical benefit in the dose reduction for the rectal wall in the use of ERB’s for prostate radiotherapy. Although the ERB position needs to be confirmed with IGRT to remove the potential for inter-fractional positional error. [Table: see text]

A novel method for decreasing rectal toxicity during prostate radiotherapy by prostate-rectum separation: An evaluation of irradiation dose parameters and acute side effects.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 227-227 ◽  
Author(s):  
Michael J. Mathers ◽  
Theodor Klotz ◽  
Yvonne Lazar ◽  
Thomas Eckl ◽  
Horst Hermani ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Acute Toxicity ◽  
Rectal Wall ◽  
Rectal Toxicity ◽  
Prostate Radiotherapy ◽  
Synthetic Hydrogel ◽  
Dose Volume ◽  
Imrt Planning ◽  
Prostate Cancers

227 Background: Prostate cancers (PCA) frequently arise in the peripheral posterior zone of the gland and therefore adjacent to the rectum. Treatment can include brachytherapy and/or radiotherapy (RT); however, rectal toxicity can complicate therapy. A dilemma therefore arises in the balance between radiation dose and rectal adverse effects. Methods: Starting February 2012, until now 37 patients were included in this investigation. Under ultrasound guidance, a synthetic hydrogel (SpaceOAR) was injected between the prostate and the rectum, thus moving the rectum away from the high radiation dose volume, allowing dose escalation. The procedure was carried out in general anaesthesia and required approx. 10 min. The prescribed dose for the prostate was 80.0 Gy in 40 fractions. In 20 patients also the pelvic lymph nodes were irradiated with 50.4 Gy. IMRT planning was realized with and without hydrogel. During the treatment and 3 months after treatment acute toxicity was documented by the use of common toxicity criteria version 3.0. Results: So far median follow up time post hydrogel injection for all patients is 6 months. No acute toxicity for the hydrogel-application was observed. In the middle plane of the gland, the space between rectal wall and prostate could be increased by an average of 1.34cm. The mean V70 with hydrogel was 1.6% (range 0-8%) and without hydrogel 17.3% (range 8- 42%) resulting in a mean reduction of V70 of 90,9%. Until now 24 patients finished RT. 14 of these patients showed gastrointestinal toxicity (GIT) grade 1. No grade 2. GIT was observed. 13 patients reached the first follow up 3 months after RT. Only 2 of these patients showed GIT grade 1. No GIT grade 2 was described. Conclusions: Injected liquid to solid inert substance for prostate-rectum separation appears to be safe. Reducing rectal irradiation doses has the potential to lower rates of rectal toxicity and therefore improving QOL in men receiving RT for prostate cancer. More research is needed before conclusions can be reached as to the technology’s potential place in therapy.

Rectal wall sparing effect of three different endorectal balloons in 3D conformal and IMRT prostate radiotherapy

2005 ◽  
Vol 63 (2) ◽  
pp. 565-576 ◽  
Author(s):  
Emile N.J. Th. van Lin ◽  
Aswin L. Hoffmann ◽  
Peter van Kollenburg ◽  
Jan Willem Leer ◽  
Andries G. Visser
Keyword(s):  
Rectal Wall ◽  
Prostate Radiotherapy ◽  
Sparing Effect
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