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

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.

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512 Poster Quantification of the small bowel exclusion from the pelvic high dose volume

Radiotherapy and Oncology ◽

10.1016/s0167-8140(02)82823-7 ◽

2002 ◽

Vol 64 ◽

pp. S163

Keyword(s):

Small Bowel ◽

High Dose ◽

Dose Volume

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One year experience of OMOM Capsule Endoscopy for suspected intestine lesions

Journal of Nobel Medical College ◽

10.3126/jonmc.v1i1.7285 ◽

2012 ◽

Vol 1 (1) ◽

pp. 27-39 ◽

Cited By ~ 3

Author(s):

Mohan Khadka ◽

Xiaohong Tao ◽

Dao-Rong Chen ◽

Shun-Wen Wang ◽

Sai Gu

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Diagnostic Efficacy ◽

Medical College ◽

Non Invasive ◽

Intestinal Lesions ◽

One Year ◽

The Cost

Background: Capsule endoscopy (CE), is a superior non-invasive tool in the diagnosis of suspected small bowel lesions to conventional modalities. This study has been carried out with the aim to share the experience and to evaluate the efficacy of OMOM CE. The objectives have been set to find out and compare the diagnostic yields of the CE for obscure gastrointestinal bleeding (OGB) and unexplained abdominal pain and/or diarrhea and also to see the cost effectiveness and quality of the CE. Methods: OMOM CE examination was conducted in consecutive 46 admitted patients presented with suspected small intestinal lesions over a period of one year. The indications were OGB, unexplained abdominal pain and diarrhea. Results: Abnormal findings were revealed in 42 out of which 36 subjects revealed significant abnormal findings in small bowel. Overall diagnostic efficacy of the CE was 80% and Diagnostic yield was significantly higher for OGB (26/27) in comparison to unexplained abdominal pain and/or diarrhea (96.30% vs 55.55%, P < 0.001). Angioectasia was the major finding for OGB cases. No complications were observed with the CE examination. Conclusion: OMOM CE has high diagnostic yield for OGB and unexplained abdominal pain or diarrhea and effectiveness is comparable with Pillcam CE.DOI: http://dx.doi.org/10.3126/jonmc.v1i1.7285 Journal of Nobel Medical College Vol.1(1) 2011 27-39

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Dose–volume analysis of predictors for chronic gastrointestinal complications in patients with cervical cancer treated with postoperative concurrent chemotherapy and whole-pelvic radiation therapy

Journal of Radiation Research ◽

10.1093/jrr/rrw037 ◽

2016 ◽

Vol 57 (6) ◽

pp. 668-676 ◽

Cited By ~ 3

Author(s):

Fumiaki Isohashi ◽

Seiji Mabuchi ◽

Yuichi Akino ◽

Yasuo Yoshioka ◽

Yuji Seo ◽

...

Keyword(s):

Cervical Cancer ◽

Radiation Therapy ◽

Small Bowel ◽

Concurrent Chemotherapy ◽

Bowel Loop ◽

High Dose ◽

Operating Characteristics ◽

Gastrointestinal Complications ◽

Pelvic Radiation ◽

Dose Volume

Abstract The purpose of this study is to evaluate dose–volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in patients with cervical cancer who have undergone postoperative concurrent chemotherapy and whole-pelvic radiation therapy (WPRT). The subjects were 135 patients who had undergone postoperative WPRT with concurrent nedaplatin-based chemotherapy between 2000 and 2014. Associations between selected DVH parameters and the incidence of chronic GI complications of G3 or higher were evaluated. Chronic GI complications of severity G3 occurred in 18 (13%) patients. Patients with GI complications had significantly greater V5–V45, mean dose and the generalized equivalent uniform dose (gEUD) of the small bowel loops, compared with those without GI complications. V30–V45, mean dose and gEUD of the bowel bag also showed significant differences between patients with and without GI complications. In contrast, no parameter for the large bowel loop was correlated with GI complications. Receiver operating characteristics curve analysis indicated that V30–V45 of the small bowel loops were better predictors than these respective parameters for the bowel bag. Next, patients were divided into four groups based on the median V15 and V40 of the small bowel loops. The group with both a high V15 and a high V40 showed a significantly higher probability of chronic GI complications. In conclusion, the small bowel loops are better predictors of chronic GI complications compared with the bowel bag, and a relatively high-dose volume (e.g. V40) of the small bowel loops is a useful predictor of chronic GI complications.

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Acute radiation enteritis causing small bowel obstruction

Annals of The Royal College of Surgeons of England ◽

10.1308/147870811x602122 ◽

2011 ◽

Vol 93 (7) ◽

pp. e129-e130 ◽

Cited By ~ 1

Author(s):

NJ Curtis ◽

T Bryant ◽

S Raj ◽

AR Bateman ◽

AH Mirnezami

Keyword(s):

Side Effects ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Acute Radiation ◽

Radiation Enteritis ◽

Oncological Disease ◽

Acute Complications ◽

Effects Of Radiation

Although much is known about the late intestinal side effects of radiation, comparatively little has been published about its acute complications. We present a case of a small bowel obstruction due to acute radiation enteritis. As radiotherapy continues to expand its role in the management of oncological disease, clinicians should remain alert to the resulting undesired effects.

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