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Title: Patient tolerance of rectal balloons in conformal radiation treatment of prostate cancer

Abstract

Purpose: To evaluate patient tolerance of intrarectal balloons used during conformal prostate irradiation. Methods and Materials: A retrospective analysis was performed on 3,561 patients who underwent conformal radiation for prostate cancer. Therapy consisted of proton irradiation of the prostate and seminal vesicles and X-ray treatment of the pelvis when warranted. The number of treatments in which the balloon was tolerated was recorded. Results were stratified according to method of irradiation (protons alone vs. combined proton/X-ray) and method of planning (2D vs. 3D planning of X-ray fields in patients undergoing combination treatment). Results: Of all the patients evaluated, 3,474 (97.6%) tolerated the balloon throughout treatment; 87 (2.4%) declined the balloon for 1 or more treatments and tolerated the balloon for 85.5% of their treatments. Chi-square analysis revealed a significant tolerance advantage in those who received protons alone compared with combination treatment (99.5% vs. 95.7%; p < 0.001). In patients undergoing combination treatment, chi-square analysis did not reveal significant tolerance differences in patients undergoing 3D vs. 2D planning for pelvic X-ray fields (95.74% vs. 95.72%; p = 0.990). Conclusions: Intrarectal balloons are well tolerated over a course of conformal prostate irradiation.

Authors:
 [1];  [1];  [1];  [1];  [2]
  1. Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA (United States)
  2. Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA (United States). E-mail: jdslater@dominion.llumc.edu
Publication Date:
OSTI Identifier:
20793420
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 64; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2005.11.001; PII: S0360-3016(05)02866-X; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; IRRADIATION; NEOPLASMS; PATIENTS; PELVIS; PLANNING; PROSTATE; PROTON BEAMS; RADIOTHERAPY; TOLERANCE; X RADIATION

Citation Formats

Ronson, Brian B., Yonemoto, Les T., Rossi, Carl J., Slater, James M., and Slater, Jerry D. Patient tolerance of rectal balloons in conformal radiation treatment of prostate cancer. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.1.
Ronson, Brian B., Yonemoto, Les T., Rossi, Carl J., Slater, James M., & Slater, Jerry D. Patient tolerance of rectal balloons in conformal radiation treatment of prostate cancer. United States. doi:10.1016/J.IJROBP.2005.1.
Ronson, Brian B., Yonemoto, Les T., Rossi, Carl J., Slater, James M., and Slater, Jerry D. Sat . "Patient tolerance of rectal balloons in conformal radiation treatment of prostate cancer". United States. doi:10.1016/J.IJROBP.2005.1.
@article{osti_20793420,
title = {Patient tolerance of rectal balloons in conformal radiation treatment of prostate cancer},
author = {Ronson, Brian B. and Yonemoto, Les T. and Rossi, Carl J. and Slater, James M. and Slater, Jerry D.},
abstractNote = {Purpose: To evaluate patient tolerance of intrarectal balloons used during conformal prostate irradiation. Methods and Materials: A retrospective analysis was performed on 3,561 patients who underwent conformal radiation for prostate cancer. Therapy consisted of proton irradiation of the prostate and seminal vesicles and X-ray treatment of the pelvis when warranted. The number of treatments in which the balloon was tolerated was recorded. Results were stratified according to method of irradiation (protons alone vs. combined proton/X-ray) and method of planning (2D vs. 3D planning of X-ray fields in patients undergoing combination treatment). Results: Of all the patients evaluated, 3,474 (97.6%) tolerated the balloon throughout treatment; 87 (2.4%) declined the balloon for 1 or more treatments and tolerated the balloon for 85.5% of their treatments. Chi-square analysis revealed a significant tolerance advantage in those who received protons alone compared with combination treatment (99.5% vs. 95.7%; p < 0.001). In patients undergoing combination treatment, chi-square analysis did not reveal significant tolerance differences in patients undergoing 3D vs. 2D planning for pelvic X-ray fields (95.74% vs. 95.72%; p = 0.990). Conclusions: Intrarectal balloons are well tolerated over a course of conformal prostate irradiation.},
doi = {10.1016/J.IJROBP.2005.1},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 64,
place = {United States},
year = {Sat Apr 01 00:00:00 EST 2006},
month = {Sat Apr 01 00:00:00 EST 2006}
}
  • Purpose: To explore the feasibility of pretreatment test for iso-NTCP DGART and to compare the pretreatment test results with post-treatment evaluations. Methods: NTCP here refers to late rectal wall toxicity only and is calculated with the ring rectal wall DVH. Simulation for one time iso- NTCP DGART starts after half of the total dose was done for 10 patients to investigate if TCP gains could be achieved. Six patients were treated using a 12-fraction 4.3Gy technique and four using 16-fraction 3.63Gy technique. For each of the 12-fraction cases a VMAT plan was generated in Pinnacle3™ using the daily CT obtainedmore » prior to the 6th fraction. A pretreatment simulation was performed using only the first 6 daily CTs. The idea is to add the 6 original plan delivered doses with 6 DGART plan delivered doses by deformable dose accumulation (DDA) on each of the first 6 CTs, resulting in 6 rectal wall doses (RWDs) and NTCPs. The 95% confidence interval (95%CI) for the 6 NTCPs were computed.The posttreatment evaluation was done by: a) copy the DGART plan to 6 CTs for fraction 7–12 and calculate the 6 actual DGART delivered fractional doses; b) sum the 6 actual DGART doses with the 6 original plan delivered doses by DDA on each of the 12 CTs resulting in 12 post-treatment RWDs and NTCPs; c) boxplot the 12 post-treatment NTCPs. Results: Target dose gain is 0.76–1.93 Gy. The 95%CI widths of the pretreatment tests NTCPs were 1.1–2.7%. For 5 patients, the planned NTCP fell within the 95%CI. For 4 patients, the planned NTCP was lower than the 95%CI lines. Post-treatment results show that for 7 patients, the upper quartile was within the 95%CI; for 2 patients, the upper quartile were higher than the 95%CI. Conclusion: The pretreatment test yields conservative prediction of the actual delivered NTCP.« less
  • Purpose: To investigate the dosimetric consequences and rectal wall (Rwall) sparing effect of three different endorectal balloons (ERBs) for three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for prostate cancer. Methods and Materials: In 20 patients, 4 planning computed tomography scans were made: 1 without ERB and 3 with ERB1, ERB2, or ERB3 inserted. Two different planning target volumes were defined: prostate only, and prostate plus seminal vesicles. The 3D-CRT and IMRT planning techniques were used, and the prescription dose was 78 Gy. In 284 treatment plans, the Rwall mean dose, the Rwall normal tissue complication probability, and the absolutemore » Rwall volumes exposed to {>=}50 Gy (V{sub 50}) and {>=}70 Gy (V{sub 70}) were calculated. For spatial dose distribution analysis, inner rectal wall dose maps and dose surface histograms were generated. Results: Each ERB was tolerated well. In the case of 3D-CRT, each ERB showed a statistically significant reduction of all the measured parameters. ERB2 and ERB3 performed better than ERB1. In IMRT, a statistically significant reduction in the Rwall dose parameters could not be demonstrated for any of the ERBs. For 3D-CRT and IMRT, as a result of the rectal dilation, ranging from 8 to 20 cm in circumference, the ERBs resulted in a reduction of the relative inner Rwall surface exposed to intermediate and high doses. Conclusions: In 3D-CRT, any ERB showed a significant rectal wall sparing effect. ERB2 and ERB3 were superior to ERB1. For both 3D-CRT and IMRT, a reduction of the relative inner Rwall surface exposed to intermediate and high doses was found, which may lead to reduced late rectal toxicity. Development of user- and patient-friendly ERBs is warranted to increase their acceptability.« less
  • Purpose: To convey the occurrence of isolated cases of severe rectal toxicity at the highest dose level tested in 5-fraction stereotactic body radiation therapy (SBRT) for localized prostate cancer; and to rationally test potential causal mechanisms to guide future studies and experiments to aid in mitigating or altogether avoiding such severe bowel injury. Methods and Materials: Clinical and treatment planning data were analyzed from 91 patients enrolled from 2006 to 2011 on a dose-escalation (45, 47.5, and 50 Gy in 5 fractions) phase 1/2 clinical study of SBRT for localized prostate cancer. Results: At the highest dose level, 6.6% ofmore » patients treated (6 of 91) developed high-grade rectal toxicity, 5 of whom required colostomy. Grade 3+ delayed rectal toxicity was strongly correlated with volume of rectal wall receiving 50 Gy >3 cm{sup 3} (P<.0001), and treatment of >35% circumference of rectal wall to 39 Gy (P=.003). Grade 2+ acute rectal toxicity was significantly correlated with treatment of >50% circumference of rectal wall to 24 Gy (P=.010). Conclusion: Caution is advised when considering high-dose SBRT for treatment of tumors near bowel structures, including prostate cancer. Threshold dose constraints developed from physiologic principles are defined, and if respected can minimize risk of severe rectal toxicity.« less
  • Purpose: We examined whether rectal dose-volume histogram (DVH) parameters were associated with long-term patient-reported gastrointestinal (GI) quality of life (QOL) after conventional (70.2 GyE) or high-dose (79.2 GyE) radiation for prostate cancer. Methods and Materials: Of 64 men with localized prostate cancer alive with a minimum 7-year follow-up after treatment as part of a randomized trial with either 70.2 GyE or 79.2 GyE of external beam radiation at Massachusetts General Hospital, 56 men (88%) returned a QOL questionnaire, and 50 of those men had DVH information. The DVH parameters of the anterior rectal wall were correlated with patient-reported long-term GImore » QOL using Pearson correlation and t tests. Results: There was a trend toward an association between increased long-term GI dysfunction and higher V60 (p = 0.07), V65 (p = 0.06), V70 (p = 0.09), and V75 (p = 0.09). When dichotomized by their medians, a V60 > 54% (p = 0.04), V70 > 44% (p = 0.06), and V75 > 39% (p = 0.06) were associated with increased long-term GI dysfunction. There was no difference in long-term GI dysfunction between men on the conventional vs. high-dose arms (p = 0.49). Conclusions: Dose-volume histogram parameters of the anterior rectal wall were associated with long-term patient-reported GI QOL after prostate radiation, whereas the dose prescribed to the prostate was not, suggesting that DVH constraints, rather than total prescribed dose, may have the greatest impact on long-term bowel dysfunction, and therefore that continued dose escalation may be feasible if appropriate dose-volume constraints are met.« less
  • Purpose: To determine if differences in patient positioning methods have an impact on the incidence and modeling of grade >=2 acute rectal toxicity in prostate cancer patients who were treated with Intensity Modulated Radiation Therapy (IMRT). Methods: We compared two databases of patients treated with radiation therapy for prostate cancer: a database of 79 patients who were treated with 7 field IMRT and daily image guided positioning based on implanted gold markers (IGRTdb), and a database of 302 patients who were treated with 5 field IMRT and daily positioning using a trans-abdominal ultrasound system (USdb). Complete planning dosimetry was availablemore » for IGRTdb patients while limited planning dosimetry, recorded at the time of planning, was available for USdb patients. We fit Lyman-Kutcher-Burman (LKB) model to IGRTdb only, and Univariate Logistic Regression (ULR) NTCP model to both databases. We perform Receiver Operating Characteristics analysis to determine the predictive power of NTCP models. Results: The incidence of grade >= 2 acute rectal toxicity in IGRTdb was 20%, while the incidence in USdb was 54%. Fits of both LKB and ULR models yielded predictive NTCP models for IGRTdb patients with Area Under the Curve (AUC) in the 0.63 – 0.67 range. Extrapolation of the ULR model from IGRTdb to planning dosimetry in USdb predicts that the incidence of acute rectal toxicity in USdb should not exceed 40%. Fits of the ULR model to the USdb do not yield predictive NTCP models and their AUC is consistent with AUC = 0.5. Conclusion: Accuracy of a patient positioning system affects clinically observed toxicity rates and the quality of NTCP models that can be derived from toxicity data. Poor correlation between planned and clinically delivered dosimetry may lead to erroneous or poorly performing NTCP models, even if the number of patients in a database is large.« less