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Reduction of rectal doses by removal of gas in the rectum during vaginal cuff brachytherapy

Reduktion der Rektumbelastung durch Ablassen der Rektumluft vor intravaginaler Brachytherapie

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Abstract

Objective

The goal of this work was to evaluate whether the volume reduction related to removal of gas in the rectum could be translated in lower doses to organs at risk (OAR) during vaginal cuff brachytherapy (VBT).

Material and methods

Fourteen pairs of brachytherapy planning CT scans derived from 11 patients were re-segmented and re-planned using the same parameters. The only difference between pairs of CTs was the presence or lack of gas in the rectum. The first CT showed the basal status and the second was carried out after gas removal with a tube. A set of values derived from bladder and rectum dose–volume histograms (DVH) and dose–surface histograms (DSH) were extracted. Moreover the cylinder position related to the patient craniocaudal axis was recorded.

Results

Rectum volume decreased significantly from 77.8 ± 45 to 55.43 ± 17.6 ml (p = 0.0052) after gas removal. Such volume diminution represented a significant reduction on all rectal DVH parameters analyzed except D25 % and D50 %. DSH parameter results were similar to previous ones. A nonsignificant increase of the bladder volume was observed and was associated with an increase of the DVH metrics analyzed.

Conclusion

Removal of gas pockets is a simple and inexpensive maneuver that decreases rectal dose parameters on VBT, which can be translated as a better therapeutic ratio. It also suggests that other actions directed to empty the rectum could have a similar effect.

Zusammenfassung

Ziel

Ziel dieser Arbeit war die Untersuchung, ob die Volumenreduktion des Rektums durch Ablassen der dort vorhandenen Luft zur Senkung der Dosen in den Risikoorganen (OAR) bei intravaginaler Brachytherapie führt.

Material und Methoden

Vierzehn Planungs-CT-Serien von 11 Patientinnen wurden zur Konturierung und Planung verwendet. Anschließend wurden die 14 CT-Serien nach Ablassen der Luft im Rektum mit Hilfe einer Sonde wiederholt und es erfolgte eine erneute Konturierung und Planung. Verwendet wurden immer dieselben Parameter. Rektum- und Blasenparameter vor und nach Ablassen der Rektumluft wurden im Dosis-Volumen-Histogramm (DVH) und im Dosis-Oberflächen-Histogramm (DSH) ausgewertet. Zudem wurde die Vaginalzylinderposition bezüglich der kraniokaudalen Achse der Patientinnen notiert.

Ergebnis

Das Rektumvolumen sank erheblich von 77,8 ± 45 auf 55,43 ± 17,6 ml (p = 0,0052), nachdem die Luft aus dem Rektum entfernt worden war. Die Volumenminderung führte zu einer signifikanten Senkung der Belastungswerte aller Rektumparameter im DVH, außer bei den Volumina D25 % und D50 %. Die Ergebnisse der DSH-Parameter waren denen der DVH-Parameter ähnlich. Eine statistisch nicht signifikante Steigerung des Blasenvolumens wurde nach Ablassen der Rektumluft beobachtet und mit einer Steigerung der Belastungswerte der analysierten DVH-Parameter für die Blase korreliert.

Schlussfolgerung

Das Entfernen von Luft aus dem Rektum mittels einer Sonde ist ein einfaches und kostengünstiges Verfahren, um die Rektumbelastung bei Verwendung der intravaginalen Brachytherapie zu senken und damit die therapeutische Ratio zu verbessern. Daraus kann auch gefolgert werden, dass andere Verfahren, die das Rektum reinigen, eine ähnliche Wirkung haben könnten.

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Compliance with ethical guidelines

Conflict of interest. S. Sabater, Mª M. Sevillano, I. Andres, R. Berenguer, S. Machin-Hamalainen, K. Müller, and M. Arenas state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Sabater, S., Sevillano, M., Andres, I. et al. Reduction of rectal doses by removal of gas in the rectum during vaginal cuff brachytherapy. Strahlenther Onkol 189, 951–956 (2013). https://doi.org/10.1007/s00066-013-0427-x

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  • DOI: https://doi.org/10.1007/s00066-013-0427-x

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