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20.02.2017 | Original Article

Small bowel protection in IMRT for rectal cancer

A dosimetric study on supine vs. prone position

verfasst von: Julia Koeck, M.D., Katharina Kromer, Frank Lohr, M.D., Tobias Baack, M.D., Kerstin Siebenlist, Sabine Mai, M.D., Sylvia Büttner, Jens Fleckenstein, Ph.D., Frederik Wenz, M.D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 7/2017

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Abstract

Background

This treatment planning study analyzes dose coverage and dose to organs at risk (OAR) in intensity-modulated radiotherapy (IMRT) of rectal cancer and compares prone vs. supine positioning as well as the effect of dose optimization for the small bowel (SB) by additional dose constraints in the inverse planning process.

Patients and methods

Based on the CT datasets of ten male patients in both prone and supine position, a total of four different IMRT plans were created for each patient. OAR were defined as the SB, bladder, and femoral heads. In half of the plans, two additional SB cost functions were used in the inverse planning process.

Results

There was a statistically significant dose reduction for the SB in prone position of up to 41% in the high and intermediate dose region, compared with the supine position. Furthermore, the femoral heads showed a significant dose reduction in prone position in the low dose region. Regarding the additional active SB constraints, the dose in the high dose region of the SB was significantly reduced by up to 14% with the additional cost functions. There were no significant differences in the dose distribution of the planning target volume (PTV) and the bladder.

Conclusion

Prone positioning can significantly reduce dose to the SB in IMRT for rectal cancer and therefore should not only be used in 3D conformal radiotherapy but also in IMRT of rectal cancer. Further protection of the SB can be achieved by additional dose constraints in inverse planning without jeopardizing the homogeneity of the PTV.

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Titel: Small bowel protection in IMRT for rectal cancer
A dosimetric study on supine vs. prone position
verfasst von: Julia Koeck, M.D.
Katharina Kromer
Frank Lohr, M.D.
Tobias Baack, M.D.
Kerstin Siebenlist
Sabine Mai, M.D.
Sylvia Büttner
Jens Fleckenstein, Ph.D.
Frederik Wenz, M.D.
Publikationsdatum: 20.02.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 7/2017
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1107-z

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Small bowel protection in IMRT for rectal cancer

A dosimetric study on supine vs. prone position