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Rectal retractor application during image-guided dose-escalated prostate radiotherapy.

Seied Rabi Mahdavi1, Hamed Ghaffari2, Bahram Mofid3

  • 1Junction of Shahid Hemmat and Chamran Expressways, Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Strahlentherapie Und Onkologie : Organ Der Deutschen Rontgengesellschaft ... [Et Al]
|March 3, 2019
PubMed
Summary

A rectal retractor (RR) significantly reduces rectal dose during prostate 3DCRT, improving patient outcomes. This device offers a safe and effective method for in vivo dosimetry verification, potentially lowering rectal toxicity.

Keywords:
Conformal radiotherapyImage guided radiotherapyProstate cancerRectal retractorRectal toxicity

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Urology

Background:

  • Image-guided radiotherapy (IGRT) for prostate cancer requires precise dose delivery.
  • Minimizing rectal dose is crucial to reduce toxicity in prostate radiotherapy.
  • Three-dimensional conformal radiotherapy (3DCRT) is a standard treatment modality.

Purpose of the Study:

  • To evaluate the efficacy of a rectal retractor (RR) in reducing rectal dose during image-guided dose-escalated prostate 3DCRT.
  • To assess the safety and tolerance of the RR in patients undergoing prostate radiotherapy.

Main Methods:

  • Twenty-one patients with localized prostate cancer received 3DCRT with an RR.
  • Radiotherapy planning scans were performed with and without the RR.
  • In vivo dosimetry was performed using a Pinpoint chamber integrated into the RR in 6 patients.
  • Patient tolerance and acute rectal toxicity were assessed using CTCAE v.4.0.

Main Results:

  • The RR significantly reduced rectal wall dose-volume parameters, with mean rectal wall dose decreasing from 43.0 Gy to 29.4 Gy.
  • Patients tolerated the RR well, experiencing only mild anal irritation.
  • Acute toxicities, including Grade 1 diarrhea, rectal urgency, and proctitis, were observed in a small number of patients.
  • No Grade 2 or higher acute rectal toxicities occurred.

Conclusions:

  • Rectal retraction effectively reduces rectal dose during prostate 3DCRT, with a favorable safety profile.
  • The integrated dosimeter in the RR provides a practical method for in vivo dose verification.
  • Further clinical studies are warranted to confirm the long-term clinical benefits of RR in reducing rectal toxicity.