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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 11/2018

01-11-2018 | Original Article

A treatment planning study of prone vs. supine positions for locally advanced rectal carcinoma

Comparison of 3‑dimensional conformal radiotherapy, tomotherapy, volumetric modulated arc therapy, and intensity-modulated radiotherapy

Authors: Sergiu Scobioala, M.D., Christopher Kittel, Philipp Niermann, Heidi Wolters, Ph.D., Katharina Helene Susek, M.D., Uwe Haverkamp, Ph.D., Hans Theodor Eich, M.D., Ph.D.

Published in: Strahlentherapie und Onkologie | Issue 11/2018

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Abstract

Purpose

To ascertain the optimal radiation technique and radiation position for the neoadjuvant radiotherapy of patients with rectal cancer.

Materials and methods

Treatment plans with similar dose objectives were generated for 20 selected patients. Dosimetric comparison was performed between prone and supine positions and between different radiation techniques. Dosimetric indices for the target volume and organs at risk (OAR) as well as normal tissue complication probability (NTCP) of late small bowel toxicity were analyzed.

Results

The helical tomotherapy (HT) in the prone position provided the optimal dose homogeneity in the target volume with the value of 0. Superior conformity values were obtained for Sliding Window (SW), Rapid Arc (RA) and HT compared to three-dimensional conformal radiotherapy (3D-CRT) techniques. All of the techniques showed dose reduction to OAR in the high-dose area in prone position versus supine position. Pairwise comparison revealed significantly higher small bowel protection by RA in the prone position in the high-dose area (V75, V45Gy). Similarly, superior bladder sparing was found for 3D-CRT in the prone position at higher doses (V50, V75). More healthy tissue in the radiation volume was involved by application of 3D-CRT with no relevant difference between positions. The mean values of NTCP for the small bowel did not show clinically meaningful variation between the techniques.

Conclusion

All techniques provided superior sparing of OAR in the prone position. At higher radiation doses, treatment in prone position resulted in significant OAR protection, especially concerning small bowel sparing by RA and bladder sparing by 3D CRT.
Appendix
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Literature
1.
2.
3.
4.
Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701CrossRef
5.
Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373:811–820CrossRef
6.
Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRef
7.
Sauer R, Liersch T, Merkel S et al (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30:1926–1933CrossRef
8.
Roh MS, Colangelo LH, O’Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R‑03. J Clin Oncol 27:5124–5130CrossRef
9.
Arbea L, Ramos LI, Martínez-Monge R et al (2010) Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications. Radiat Oncol 26(5):17CrossRef
10.
Baglan KL, Frazier RC, Yan D et al (2002) The dose-volume relationship of acute small bowel toxicity from concurrent 5‑FU-based chemotherapy and radiation therapy for rectal cancer. Int J Radiat Oncol Biol Phys 52:176–183CrossRef
11.
Tho LM, Glegg M, Paterson J et al (2006) Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: investigating dose-volume relationships and role for inverse planning. Int J Radiat Oncol Biol Phys 66:505–513CrossRef
12.
Robertson JM, Lockman D, Yan D, Wallace M (2008) The dose-volume relationship of small bowel irradiation and acute grade 3 diarrhea during chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 70:413–418CrossRef
13.
Zhao J, Hu W, Cai G et al (2016) Dosimetric comparisons of VMAT, IMRT and 3DCRT for locally advanced rectal cancer with simultaneous integrated boost. Oncotarget 7:6345–6351PubMed
14.
Lin JC, Tsai JT, Chen LJ et al (2017) Compared planning dosimetry of TOMO, VMAT and IMRT in rectal cancer with different simulated positions. Oncotarget 8:42020–42029PubMedPubMedCentral
15.
Guerrero Urbano MT, Henrys AJ, Adams EJ et al (2006) Intensity-modulated radiotherapy in patients with locally advanced rectal cancer reduces volume of bowel treated to high dose levels. Int J Radiat Oncol Biol Phys 65:907–916CrossRef
16.
Richetti A, Fogliata A, Clivio A et al (2010) Neo-adjuvant chemo-radiation of rectal cancer with volumetric modulated arc therapy: summary of technical and dosimetric features and early clinical experience. Radiat Oncol 5:14CrossRef
17.
White R, Foroudi F, Sia J et al (2016) Reduced dose to small bowel with the prone position and a belly board versus the supine position in neoadjuvant 3D conformal radiotherapy for rectal adenocarcinoma. J Med Radiat Sci 64:120–124CrossRef
18.
Drzymala M, Hawkins MA, Henrys AJ et al (2009) The effect of treatment position, prone or supine, on dose-volume histograms for pelvic radiotherapy in patients with rectal cancer. Br J Radiol 82:321–327CrossRef
19.
Nijkamp J, Doodeman B, Marijnen C et al (2012) Bowel exposure in rectal cancer IMRT using prone, supine, or a belly board. Radiother Oncol 102:22–29CrossRef
20.
Lyman JT (1985) Complication probability as assessed from dose-volume histograms. Radiat Res Suppl 8:13–19CrossRef
21.
Kutcher GJ, Burmann C, Brewster L (1991) Histogram reduction method for calculating complication probabilities for three-dimensional treatment planning. Int J Radiat Oncol Biol Phys 21:137–146CrossRef
22.
Robertson JM, Lockman D, Yan D, Wallace M (2008) The dose-volume relationship of small bowel irradiation and acute grade 3 diarrhea during chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 70:413–418CrossRef
23.
24.
Myerson RJ, Garofalo MC, El Naqa I et al (2009) Elective clinical target volumes for conformal therapy in anorectal cancer: a radiation therapy oncology group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys 74:824–830CrossRef
25.
Daly ME, Murphy JD, Mok E et al (2011) Rectal and bladder deformation and displacement during preoperative radiotherapy for rectal cancer: Are current margin guidelines adequate for conformal therapy? Pract Radiat Oncol 1:85–94CrossRef
26.
27.
ICRU (2010) Prescribing, recording, and reporting intensity-modulated photon-beam. Report 83. International Commission on Radiation Units and Measurements, Bethesda
28.
Kavanagh BD, Pan CC, Dawson LA et al (2010) Radiation dose-volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys 76:101–107CrossRef
29.
Michalski JM, Gay H, Jackson A et al (2010) Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys 76:123–129CrossRef
30.
Viswanathan AN, Yorke ED, Marks LB et al (2010) Radiation dose-volume effects of the urinary bladder. Int J Radiat Oncol Biol Phys 76:116–122CrossRef
31.
Bentzen SM, Constine LS, Deasy JO et al (2010) Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues. Int J Radiat Oncol Biol Phys 76:3–9CrossRef
32.
Haverkamp U, Norkus D, Kriz J et al (2014) Optimization by visualization of indices. Strahlenther Onkol 190:1053–1059CrossRef
33.
Marks LB, Yorke ED, Jackson A et al (2010) Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 76:10–19CrossRef
34.
Kim TH, Chie EK, Kim DY et al (2005) Comparison of the belly board device method and the distended bladder method for reducing irradiated small bowel volumes in preoperative radiotherapy of rectal cancer patients. Int J Radiat Oncol Biol Phys 62:769–775CrossRef
35.
Lee SH, Kim TH, Kim DY et al (2006) The effect of belly board location in rectal cancer patients treated with preoperative radiotherapy. Clin Oncol 18:441–446CrossRef
36.
Kim JY, Kim DY, Kim TH et al (2007) Intensity-modulated radiotherapy with a belly board for rectal cancer. Int J Colorectal Dis 22:373–379CrossRef
37.
Yoon WS, Yang DS, Lee JA et al (2012) Risk factors related to interfractional variation in whole pelvic irradiation for locally advanced pelvic malignances. Strahlenther Onkol 188:395–401CrossRef
38.
Fu YT, Lam JC, Tze JM (1995) Measurement of irradiated small bowel volume in pelvic irradiation and the effect of a bellyboard. Clin Oncol 7:188–192CrossRef
39.
Froseth TC, Strickert T, Solli KS et al (2015) A randomized study of the effect of patient positioning on setup reproducibility and dose distribution to organs at risk in radiotherapy of rectal cancer patients. Radiat Oncol 10:217CrossRef
40.
Cranmer-Sargison G, Kundapur V, Park-Somers E et al (2013) Planning target volume margin evaluation and critical structure sparing for rectal cancer patients treated prone on a bellyboard. Clin Oncol 25:17–22CrossRef
41.
Mok H, Crane CH, Palmer MB (2011) Intensity modulated radiation therapy (IMRT): differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma. Radiat Oncol 6:63CrossRef
42.
Liu M, Liu B, Wang H et al (2015) Dosimetric comparative study of 3 different postoperative radiotherapy techniques (3D-CRT, IMRT, and RapidArc) for II–III stage rectal cancer. Medicine (Baltimore) 94:e372CrossRef
43.
Weber HE, Dröge LH, Hennies S (2015) Volumetric intensity-modulated arc therapy vs. 3‑dimensional conformal radiotherapy for primary chemoradiotherapy of anal carcinoma: effects on treatment-related side effects and survival. Strahlenther Onkol 191:827–834CrossRef
44.
Koeck J, Kromer K, Lohr F et al (2017) Small bowel protection in IMRT for rectal cancer : a dosimetric study on supine vs. prone position. Strahlenther Onkol 193:578–588CrossRef
Metadata
Title
A treatment planning study of prone vs. supine positions for locally advanced rectal carcinoma
Comparison of 3‑dimensional conformal radiotherapy, tomotherapy, volumetric modulated arc therapy, and intensity-modulated radiotherapy
Authors
Sergiu Scobioala, M.D.
Christopher Kittel
Philipp Niermann
Heidi Wolters, Ph.D.
Katharina Helene Susek, M.D.
Uwe Haverkamp, Ph.D.
Hans Theodor Eich, M.D., Ph.D.
Publication date
01-11-2018
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 11/2018
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-018-1324-0

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