Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Morphologic change of rectosigmoid colon using belly board and distended bladder protocol

  • Cho, Yeona (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
  • Chang, Jee Suk (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
  • Kim, Mi Sun (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
  • Lee, Jaehwan (Icheon Public Health Center) ;
  • Byun, Hwakyung (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
  • Kim, Nalee (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
  • Park, Sang Joon (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
  • Keum, Ki Chnag (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
  • Koom, Woong Sub (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System)
  • Received : 2015.04.23
  • Accepted : 2015.05.20
  • Published : 2015.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. Materials and Methods: Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. Results: Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). Conclusion: Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.

Keywords

References

  1. Marijnen CA, Kapiteijn E, van de Velde CJ, et al. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2002;20:817-25. https://doi.org/10.1200/JCO.20.3.817
  2. Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald RJ. Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 1998;85:526-9. https://doi.org/10.1046/j.1365-2168.1998.00601.x
  3. Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN; Norwegian Rectal Cancer Group. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 2005;7:51-7. https://doi.org/10.1111/j.1463-1318.2004.00700.x
  4. Buie WD, MacLean AR, Attard JA, Brasher PM, Chan AK. Neoadjuvant chemoradiation increases the risk of pelvic sepsis after radical excision of rectal cancer. Dis Colon Rectum 2005;48:1868-74. https://doi.org/10.1007/s10350-005-0154-1
  5. Holm T, Singnomklao T, Rutqvist LE, Cedermark B. Adjuvant preoperative radiotherapy in patients with rectal carcinoma. Adverse effects during long term follow-up of two randomized trials. Cancer 1996;78:968-76. https://doi.org/10.1002/(SICI)1097-0142(19960901)78:5<968::AID-CNCR5>3.0.CO;2-8
  6. Black WC, Gomez LS, Yuhas JM, Kligerman MM. Quantitation of the late effects of X-radiation on the large intestine. Cancer 1980;45:444-51. https://doi.org/10.1002/1097-0142(19800201)45:3<444::AID-CNCR2820450307>3.0.CO;2-#
  7. De Meerleer G, Pattyn P, Fortan L, et al. High-dose preoperative radiotherapy does not alter the strength of unilaterally irradiated colon anastomoses in rats. Int J Radiat Oncol Biol Phys 1999;44:163-70. https://doi.org/10.1016/S0360-3016(98)00561-6
  8. Ceelen W, El Malt M, Cardon A, Berrevoet F, De Neve W, Pattyn P. Influence of preoperative high-dose radiotherapy on postoperative outcome and colonic anastomotic healing: experimental study in the rat. Dis Colon Rectum 2001;44:717-21. https://doi.org/10.1007/BF02234573
  9. Karliczek A, Zeebregts CJ, Benaron DA, Coppes RP, Wiggers T, van Dam GM. Preoperative irradiation with $5{\times}5$ Gy in a murine isolated colon loop model does not cause anastomotic weakening after colon resection. Int J Colorectal Dis 2008;23:1115-24. https://doi.org/10.1007/s00384-008-0507-z
  10. Chang JS, Yoon HI, Cha HJ, et al. Bladder filling variations during concurrent chemotherapy and pelvic radiotherapy in rectal cancer patients: early experience of bladder volume assessment using ultrasound scanner. Radiat Oncol J 2013;31:41-7. https://doi.org/10.3857/roj.2013.31.1.41
  11. Yoon HI, Chung Y, Kim JH, et al. The efficacy of the change in belly board aperture location by the addition of bladder compression device for radiotherapy of rectal cancer. J Korean Soc Ther Radiol Oncol 2010;28:231-7. https://doi.org/10.3857/jkstro.2010.28.4.231
  12. Chung Y, Yoon HI, Keum KC, et al. Effect of belly board with bladder compression device on small bowel displacement from the radiotherapy field for rectal cancer. Onkologie 2013;36:241-6.
  13. Seifert WF, Wobbes T, Hoogenhout J, de Man BM, Huyben KM, Hendriks T. Intraoperative irradiation delays anastomotic repair in rat colon. Am J Surg 1995;170:256-61. https://doi.org/10.1016/S0002-9610(05)80010-8
  14. Milsom JW, Senagore A, Walshaw RK, et al. Preoperative radiation therapy produces an early and persistent reduction in colorectal anastomotic blood flow. J Surg Res 1992;53:464-9. https://doi.org/10.1016/0022-4804(92)90091-D
  15. Weiber S, Jiborn H, Zederfeldt B. Preoperative irradiation and colonic healing. Eur J Surg 1994;160:47-51.
  16. Kuzu MA, Koksoy C, Akyol FH, Uzal D, Kale T, Demirpence E. Effects of preoperative fractionated irradiation on left colonic anastomoses in the rat. Dis Colon Rectum 1998;41:370-6. https://doi.org/10.1007/BF02237494
  17. Bedirli A, Kerem M, Karahacioglu E, et al. Effects of two conventional preoperative radiation schedules on anastomotic healing in the rat colon. Eur Surg Res 2007;39:141-7.
  18. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731-40. https://doi.org/10.1056/NEJMoa040694
  19. Jestin P, Påhlman L, Gunnarsson U. Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Dis 2008;10:715-21. https://doi.org/10.1111/j.1463-1318.2007.01466.x
  20. Lee WS, Yun SH, Roh YN, et al. Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg 2008;32:1124-9. https://doi.org/10.1007/s00268-007-9451-2
  21. Koelbl O, Richter S, Flentje M. Influence of patient positioning on dose-volume histogram and normal tissue complication probability for small bowel and bladder in patients receiving pelvic irradiation: a prospective study using a 3D planning system and a radiobiological model. Int J Radiat Oncol Biol Phys 1999;45:1193-8. https://doi.org/10.1016/S0360-3016(99)00345-4
  22. Nijkamp J, Doodeman B, Marijnen C, Vincent A, van Vliet- Vroegindeweij C. Bowel exposure in rectal cancer IMRT using prone, supine, or a belly board. Radiother Oncol 2012;102:22-9. https://doi.org/10.1016/j.radonc.2011.05.076
  23. Kim TH, Kim DY, Cho KH, et al. Comparative analysis of the effects of belly board and bladder distension in postoperative radiotherapy of rectal cancer patients. Strahlenther Onkol 2005;181:601-5. https://doi.org/10.1007/s00066-005-1398-3
  24. Eckmann C, Kujath P, Schiedeck TH, Shekarriz H, Bruch HP. Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis 2004;19:128-33. https://doi.org/10.1007/s00384-003-0498-8
  25. Peeters KC, Tollenaar RA, Marijnen CA, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005;92:211-6. https://doi.org/10.1002/bjs.4806
  26. Taflampas P, Christodoulakis M, Tsiftsis DD. Anastomotic leakage after low anterior resection for rectal cancer: facts, obscurity, and fiction. Surg Today 2009;39:183-8. https://doi.org/10.1007/s00595-008-3835-2
  27. Chang JS, Keum KC, Kim NK, et al. Preoperative chemoradiotherapy effects on anastomotic leakage after rectal cancer resection: a propensity score matching analysis. Ann Surg 2014;259:516-21. https://doi.org/10.1097/SLA.0b013e31829068c5

Cited by

  1. Definitive high-dose radiotherapy with concurrent chemotherapy for locally advanced rectal cancer : A case report and literature review vol.95, pp.40, 2015, https://doi.org/10.1097/md.0000000000005059