Abstract
Purpose
To evaluate the effects of rectal enemas on rectal doses during postoperative high-dose-rate (HDR) vaginal cuff brachytherapy (VCB).
Patients and methods
This prospective trial included 59 patients. Two rectal cleansing enemas were self-administered before the second fraction, and fraction 1 was considered the basal status. Dose–volume histogram (DVH) values were generated for the rectum and correlated with rectal volume variation. Statistical analyses used paired and unpaired t-tests.
Results
Despite a significant 15 % reduction in mean rectal volume (44.07 vs. 52.15 cc, p = 0.0018), 35.6 % of patients had larger rectums after rectal enemas. No significant rectal enema-related DVH differences were observed compared to the basal data. Although not statistically significant, rectal cleansing-associated increases in mean rectal DVH values were observed: D0.1 cc: 6.6 vs. 7.21 Gy; D1 cc: 5.35 vs. 5.52 Gy; D2 cc: 4.67 vs. 4.72 Gy, before and after rectal cleaning, respectively (where Dx cc is the dose to the most exposed x cm3). No differences were observed in DVH parameters according to rectal volume increase or decrease after the enema. Patients whose rectal volume increased also had significantly larger DVH parameters, except for D5 %, D25 %, and D50 %. In contrast, in patients whose rectal volume decreased, significance was only seen for D25 % and D50 % (Dx % dose covering x % of the volume). In the latter patients, nonsignificant reductions in D2 cc, D5 cc and V5 Gy (volume receiving at least 5 Gy) were observed.
Conclusion
The current rectal enemas protocol was ineffective in significantly modifying rectal DVH parameters for HDR-VCB.
Zusammenfassung
Ziel
Beurteilung der Auswirkungen von rektalen Dosen während postoperativer High-Dose-Rate-(HDR-)Brachytherapie an der Scheidenmanschette („vaginal cuff brachytherapy“, VCB).
Patienten und Methoden
An der prospektiven Studienahmen 59 Patientinnen teil. Vor der zweiten Fraktion wurden zwei selbstverabreichte Reinigungseinläufe durchgeführt. Fraktion 1 wurde als Grundstatus betrachtet. Für das Rektum wurden Dosis-Volumen-Histogramm-(DVH-)Werte generiert und mit der rektalen Volumenvariation korreliert. Für statistische Analysen wurden t-Tests für verbundene und unverbundene Stichproben verwendet.
Ergebnisse
Trotz einer signifikanten 15%igen durchschnittlichen Reduktion des rektalen Volumens (44,07 vs. 52,15 cc; p = 0,0018) hatten 53,6% der Patientinnen nach dem rektalen Einlauf ein vergrößertes Rektum. Im Vergleich mit den Grunddaten bestanden keine signifikanten DVH-Unterschiede bezüglich der Verabreichung des rektalen Einlaufs. Eine statistisch nichtsignifikante Zunahme der durchschnittlichen rektalen DVH-Werte wurde im Zusammenhang mit der rektalen Spülung festgestellt: D0,1 cc, 6,6 vs. 7,21 Gy; D1 cc, 5,35 vs. 5,52 Gy; D2 cc, 4,67 vs. 4,72 Gy, jeweils vor und nach Rektalspülung. Bezüglich der Zunahme oder Abnahme des rektalen Volumens nach Verabreichung des Einlaufs ergaben sich keine Unterschiede in den DVH-Parametern. Die Patientinnen, deren rektales Volumen zugenommen hatte, wiesen eine signifikante Zunahme der DVH-Parameter auf, außer bei D5%, D25%, D50%. Eine Signifikanz bei Patientinnen mit einem verkleinerten rektalen Volumen wurde hingegen nur bei D25% und D50% festgestellt. Bei Letzteren wurde eine nichtsignifikante Verringerung der Werte für D2 cc, D5 cc und V5 Gy beobachtet.
Schlussfolgerung
Die Vorgehensweise für rektale Einläufe erwies sich als unzureichend für eine signifikante Veränderung von rektalen DVH-Parametern bei der HDR-VCB.
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S. Sabater, I. Andrés, M. Gascon, A. Rovirosa, M. Sevillano, R. Berenguer, C. Camacho-Lopez, M. Aguayo, M.V. Villas, and M. Arenasstate state that there are no conflicts of interest.
All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.
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Sabater, S., Andrés, I., Gascon, M. et al. Effect of rectal enemas on rectal dosimetric parameters during high-dose-rate vaginal cuff brachytherapy. Strahlenther Onkol 192, 248–253 (2016). https://doi.org/10.1007/s00066-016-0940-9
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DOI: https://doi.org/10.1007/s00066-016-0940-9