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How can the aetiological factors of rectal distension be managed to reduce interfraction prostate motion during a course of radiotherapy treatment

Published online by Cambridge University Press:  28 September 2015

Helen Bayles ,
Mark Collins  and
Melanie Clarkson
Helen Bayles*
Affiliation:
Radiotherapy Outpatient Department, The James Cook University Hospital, Middlesbrough, ClevelandUK
Mark Collins
Affiliation:
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
Melanie Clarkson
Affiliation:
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
*
Correspondence to: Helen Bayles, Radiotherapy Outpatient Department, The James Cook University Hospital, Marton Road, Middlesbrough, Cleveland TS4 3BW, UK. Tel: +0 164 285 0850 ext 54277; E-mail: helen.bayles@stees.nhs.uk
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Abstract

Aim

During radiotherapy of the prostate it is important to minimise interfraction prostate motion to allow dose escalation and reduce normal tissue damage. Rectal volume has been identified as playing a significant role in prostate motion with various methods used to reduce it. The aim was to systematically review published literature to allow evidence based recommendations to be made to current practice to reduce interfraction prostate motion.

Materials and methods

A systematic search of CINAHL, Medline, PubMed, Science Direct, NHS Evidence and The Cochrane Library was performed. Limited searches of The Society of Radiographers website, OpenGrey and COPAC were undertaken, alongside manual searches of cross references of eligible articles. The quality of included papers was measured using a pre-existing tool. The causes, consequences and solutions to manage rectal volume and its effect on prostate position were extracted, compared and evaluated to extract solutions to be implemented into clinical practice.

Results

Of the 2,339 unique articles systematically retrieved, 23 met the inclusion criteria, 15 of which discuss radiotherapy, five constipation and three flatulence.

Findings

A combined medicinal and dietary approach adaptable to departmental workflow is required to manage rectal volume, with special consideration to patients with pre-existing extrinsic factors.

Keywords

bowel gasinterfraction motionprostateradiotherapyrectal distensionrectal volume
Type
Literature Review
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 1 , March 2016 , pp. 76 - 84
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Copyright
© Cambridge University Press 2015 

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References

1.McNair, H A, Wedlake, L, McVey, G P, Thomas, K, Andreyev, J, Dearnaley, D P. Can diet combined with treatment scheduling achieve consistency of rectal filling in patients receiving radiotherapy to the prostate? Radiother Oncol 2011; 101: 471–478.CrossRefGoogle ScholarPubMed
2.Kupelian, P A, Potters, L, Khuntia, Det al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1–T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004; 58: 25–33.CrossRefGoogle ScholarPubMed
3.Graf, R, Boehmer, D F, Nadobny, J F, Budach, V F, Wust, P. Appropriate patient instructions can reduce prostate motion. Radiat Oncol 2012; 7: 125.CrossRefGoogle ScholarPubMed
4.Dearnaley, D P, Khoo, V S, Norman, A Ret al. Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial. Lancet 1999; 353: 267–272.CrossRefGoogle ScholarPubMed
5.Smitsmans, M H P, Pos, F J, de Bois, Jet al. The influence of a dietary protocol on cone beam CT-guided radiotherapy for prostate cancer patients. Int J Radiat Oncol Biol Phys 2008; 71: 1279–1286.CrossRefGoogle ScholarPubMed
6.Al-Mamgani, A, Heemsbergen, W D, Peeters, S T H, Lebesque, J V. Role of intensity-modulated radiotherapy in reducing toxicity in dose escalation for localized prostate cancer. Int J Radiat Oncol Biol Phys 2009; 73: 685–691.CrossRefGoogle ScholarPubMed
7.Michalski, J M, Gay, H, Jackson, A, Tucker, S, O’Deasy, J. Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys 2010; 76 (suppl 3): S123–S129.CrossRefGoogle ScholarPubMed
8.Nijkamp, J, Pos, F J, Nuver, T Tet al. Adaptive radiotherapy for prostate cancer using kilovoltage cone-beam computed tomography: first clinical results. Int J Radiat Oncol Biol Phys 2008; 70: 75–82.CrossRefGoogle ScholarPubMed
9.Lips, I M, A N T J, Kotte, van Gils, C H, van Leerdam, M E, van der Heide, U A, van Vulpen, M. Influence of antiflatulent dietary advice on intrafraction motion for prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81: e401–e406.CrossRefGoogle ScholarPubMed
10.Padhani, A R, Khoo, V S, Suckling, J, Husband, J E, Leach, M O, Dearnaley, D P. Evaluating the effect of rectal distension and rectal movement on prostate gland position using cine MRI. Int J Radiat Oncol Biol Phys 1999; 44: 525–533.CrossRefGoogle ScholarPubMed
11.Cheung, P, Sixel, K, Morton, Get al. Individualized planning target volumes for intrafraction motion during hypofractionated intensity-modulated radiotherapy boost for prostate cancer. Int J Radiat Oncol Biol Phys 2005; 62: 418–425.CrossRefGoogle ScholarPubMed
12.Hammoud, R, Patel, S H, Pradhan, Det al. Examining margin reduction and its impact on dose distribution for prostate cancer patients undergoing daily cone-beam computed tomography. Int J Radiat Oncol Biol Phys 2008; 71: 265–273.CrossRefGoogle ScholarPubMed
13.Griffiths, S, Stanley, S, Sydes, Met al. Recommendations on best practice for radiographer set-up of conformal radiotherapy treatment for patients with prostate cancer: experience developed during the MRC RT01 trail (ISRTCN47772397). J Radiother Pract 2005; 4: 107.CrossRefGoogle Scholar
14.Sripadam, R, Stratford, J, Henry, A M, Jackson, A, Moore, C J, Price, P. Rectal motion can reduce CTV coverage and increase rectal dose during prostate radiotherapy: a daily cone-beam CT study. Radiother Oncol 2009; 90: 312–317.CrossRefGoogle ScholarPubMed
15.Rembielak, A, Jegannathen, A, McGovern, Jet al. Does movicol affect rectal size in patients treated with radical radiotherapy to the prostate? 2011; poster presentation: NCRI Conference, Liverpool.Google Scholar
16.Langen, K M, Jones, D T L. Organ motion and its management. Int J Radiat Oncol Biol Phys 2001; 50: 265–278.CrossRefGoogle ScholarPubMed
17.Liberati, A, Altman, D G, Tetzlaff, Jet al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62: e1–e34.CrossRefGoogle ScholarPubMed
18.Scottish Intercollegiate Guidelines Network. SIGN methodology, Edinburgh. 2013; 2014. www.sign.ac.uk/methodology/checklists. Accessed on February 2014.Google Scholar
19.Yahya, S, Zarkar, A, Southgate, E, Nightingale, P, Webster, G. Which bowel preparation is best? Comparison of a high-fibre diet leaflet, daily microenema and no preparation in prostate cancer patients treated with radical radiotherapy to assess the effect on planned target volume shifts due to rectal distension. Br J Radiol 2013; 86: 20130457.CrossRefGoogle ScholarPubMed
20.Fiorino, C, Di Muzio, N, Broggi, Set al. Evidence of limited motion of the prostate by carefully emptying the rectum as assessed by daily MVCT image guidance with helical tomotherapy. Int J Radiat Oncol Biol Phys 2008; 71: 611–617.CrossRefGoogle ScholarPubMed
21.Fuji, H, Murayama, S, Niwakawa, Met al. Changes in rectal volume and prostate localization due to placement of a rectum-emptying tube. Jpn J Radiol 2009; 27: 205–212.CrossRefGoogle ScholarPubMed
22.Stillie, A L, Kron, T, Fox, Cet al. Rectal filling at planning does not predict stability of the prostate gland during a course of radical radiotherapy if patients with large rectal filling are re-imaged. Clin Oncol 2009; 21: 760–767.CrossRefGoogle Scholar
23.Anderson, N S, Yu, J B, Peschel, R E, Decker, R H. A significant decrease in rectal volume and diameter during prostate IMRT. Radiother Oncol 2011; 98: 187–191.CrossRefGoogle ScholarPubMed
24.Ki, Y, Kim, W, Nam, Jet al. Probiotics for rectal volume variation during radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2013; 87: 646–650.CrossRefGoogle ScholarPubMed
25.Smeenk, R J, Louwe, R J W, Langen, K Met al. An endorectal balloon reduces intrafraction prostate motion during radiotherapy. Int J Radiat Oncol Biol Phys 2012; 83: 661–669.CrossRefGoogle ScholarPubMed
26.Frank, S J, Dong, L, Kudchadker, R Jet al. Quantification of prostate and seminal vesicle interfraction variation during IMRT. Int J Radiat Oncol Biol Phys 2008; 71: 813–820.CrossRefGoogle ScholarPubMed
27.Melchert, C, Gez, E, Bohlen, Get al. Interstitial biodegradable balloon for reduced rectal dose during prostate radiotherapy: results of a virtual planning investigation based on the pre- and post-implant imaging data of an international multicenter study. Radiother Oncol 2013; 106: 210–214.CrossRefGoogle ScholarPubMed
28.Ogino, I, Uemura, H, Inoue, T, Kubota, Y, Nomura, K, Okamoto, N. Reduction of prostate motion by removal of gas in rectum during radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72: 456–466.CrossRefGoogle ScholarPubMed
29.Jhagra, R. Solving the problem of rectal distension. Imaging Ther Pract 2013. itp:sor.org/april/rectal-distension. Accessed on 7th February 2014.Google Scholar
30.Azpiroz, F, Levitt Michael, D. Intestinal gas. In Feldman M, Friedman L, Brandt L eds Sleisebger and Fordtran’s. Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management, 9th edition. Canada: Saunders Elsevier, 2010: 233–240.CrossRefGoogle Scholar
31.Manichanh, C, Eck, A, Varela, Eet al. Anal gas evacuation and colonic microbiota in patients with flatulence: effect of diet. Gut 2014; 63: 401–408.CrossRefGoogle ScholarPubMed
32.Wind, B T. Problems with intestinal gas. Aust Fam Physician 2013; 42: 280–283.Google Scholar
33.The Joanna Briggs Institute. Management of constipation in older adults. Best Pract 2008; 12: 1–4.Google Scholar
34.Gallagher, P, O’Mahony, D. Constipation in old age. Best Pract Res Clin Gastroenterol 2009; 23: 875–887.CrossRefGoogle ScholarPubMed
35.McCrea, G L, Miaskowski, C, Stotts, N A, Macera, L, Madhulika, G V. Pathophysiology of constipation in the older adult. World J Gastroenterol 2008; 14: 2631–2638.CrossRefGoogle ScholarPubMed
36.Leung, L, Riutta, T, Kotecha, J, Rosser, W. Chronic constipation: an evidence-based review. J Am Board Fam Med 2011; 24: 436–451.CrossRefGoogle ScholarPubMed
37.Lee-Robichaud, H, Thomas, K, Morgan, J, Nelson, R L. Cochrane review: lactulose versus polyethylene glycol for chronic constipation. Evid Based Health 2011; 6: 824–864.Google Scholar
38.Mangar, S, Coffey, J, Mcnair, Het al. Prostate radiotherapy: evaluating the effect of bladder and rectal changes on prostate movement – a CT study. Trends Med Res 2006; 1: 55–55.Google Scholar