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Jin W, Montoya C, Rich BJ, Taswell CS, Noy M, Kwon D, Spieler B, Mahal B, Abramowitz M, Yechieli R, Pollack A, Dal Pra A. A Smart Water Bottle and Companion App (HidrateSpark 3) to Improve Bladder-Filling Compliance in Patients With Prostate Cancer Receiving Radiotherapy: Nonrandomized Trial of Feasibility and Acceptability. JMIR Cancer 2024; 10:e51061. [PMID: 39255484 DOI: 10.2196/51061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/06/2023] [Accepted: 03/04/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Patients with prostate cancer undergoing radiation therapy (RT) need comfortably full bladders to reduce toxicities during treatment. Poor compliance is common with standard of care written or verbal instructions, leading to wasted patient value (PV) and clinic resources via poor throughput efficiency (TE). OBJECTIVE Herein, we assessed the feasibility and acceptability of a smartphone-based behavioral intervention (SBI) to improve bladder-filling compliance and methods for quantifying PV and TE. METHODS In total, 36 patients with prostate cancer were enrolled in a single-institution, closed-access, nonrandomized feasibility trial. The SBI consists of a fully automated smart water bottle and smartphone app. Both pieces alert the patient to empty his bladder and drink a personalized volume goal, based on simulation bladder volume, 1.25 hours before his scheduled RT. Patients were trained to adjust their volume goal and notification times to achieve comfortably full bladders. The primary end point was met if qualitative (QLC) and quantitative compliance (QNC) were >80%. For QLC, patients were asked if they prepared their bladders before daily RT. QNC was met if bladder volumes on daily cone-beam tomography were >75% of the simulation's volume. The Service User Technology Acceptability Questionnaire (SUTAQ) was given in person pre- and post-SBI. Additional acceptability and engagement end points were met if >3 out of 5 across 4 domains on the SUTAQ and >80% (15/18) of patients used the device >50% of the time, respectively. Finally, the impact of SBI on PV and TE was measured by time spent in a clinic and on the linear accelerator (linac), respectively, and contrasted with matched controls. RESULTS QLC was 100% in 375 out of 398 (94.2%) total treatments, while QNC was 88.9% in 341 out of 398 (85.7%) total treatments. Of a total score of 5, patients scored 4.33 on privacy concerns, 4 on belief in benefits, 4.56 on satisfaction, and 4.24 on usability via SUTAQ. Further, 83% (15/18) of patients used the SBI on >50% of treatments. Patients in the intervention arm spent less time in a clinic (53.24, SEM 1.71 minutes) compared to the control (75.01, SEM 2.26 minutes) group (P<.001). Similarly, the intervention arm spent less time on the linac (10.67, SEM 0.40 minutes) compared to the control (14.19, SEM 0.32 minutes) group (P<.001). CONCLUSIONS This digital intervention trial showed high rates of bladder-filling compliance and engagement. High patient value and TE were feasibly quantified by shortened clinic times and linac usage, respectively. Future studies are needed to evaluate clinical outcomes, patient experience, and cost-benefit. TRIAL REGISTRATION ClinicalTrials.gov NCT04946214; https://www.clinicaltrials.gov/study/NCT04946214.
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Affiliation(s)
- William Jin
- Department of Radiation Oncology, Jackson Memorial Hospital, Miami, FL, United States
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Christopher Montoya
- Department of Radiation Oncology, Jackson Memorial Hospital, Miami, FL, United States
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Benjamin James Rich
- Department of Radiation Oncology, Jackson Memorial Hospital, Miami, FL, United States
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Crystal Seldon Taswell
- Department of Radiation Oncology, Jackson Memorial Hospital, Miami, FL, United States
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Miguel Noy
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Deukwoo Kwon
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Benjamin Spieler
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Brandon Mahal
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Matthew Abramowitz
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Raphael Yechieli
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Alan Pollack
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Alan Dal Pra
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
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Bai F, Hu Q, Yao X, Cheng M, Zhao L, Xu L. A prospective comparative study on bladder volume measurement with portable ultrasound scanner and CT simulator in pelvic tumor radiotherapy. Phys Eng Sci Med 2024; 47:87-97. [PMID: 38019446 DOI: 10.1007/s13246-023-01344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The consistency of bladder volume is very important in pelvic tumor radiotherapy, and portable bladder scanner is a promising device to measure bladder volume. The purpose of this study was to investigate whether the bladder volume of patients with pelvic tumor treated with radiotherapy can be accurately measured using the Meike Palm Bladder Scanner PBSV3.2 manufactured in China and the accuracy of its measurement under different influencing factors. METHODS A total of 165 patients with pelvic tumor undergoing radiotherapy were prospectively collected. The bladder volume was measured with PBSV3.2 before simulated localization. CT simulated localization was performed when the bladder volume was 200-400ml. The bladder volume was measured with PBSV3.2 immediately after localization and recorded. The bladder volume was then delineated on CT simulation images and recorded. To compare the consistency of CT simulation bladder volume and bladder volume measured by PBSV3.2. To investigate the accuracy of PBSV3.2 in different sex, age, treatment purpose, and bladder volume. RESULTS There was a significant positive correlation with bladder volume on CT and PBSV3.2 (r = 0.874; p < 0.001). The mean difference between CT measured values and PBSV3.2 was (-0.14 ± 50.17) ml. The results of the different variables showed that the overall mean of PBSV3.2 and CT measurements were statistically different in the age ≥ 65 years, bladder volumes > 400ml and ≤ 400ml groups (p = 0.028, 0.002, 0.001). There was no statistical significance between the remaining variables. The volume difference between PBSV3.2 measurement and CT was 12.87ml in male patients, which was larger than that in female patients 3.27ml. Pearson correlation analysis showed that the correlation coefficient was 0.473 for bladder volume greater than 400ml and 0.868 for bladder volume less than 400ml; the correlation coefficient of the other variables ranged from 0.802 to 0.893. CONCLUSION This is the first large-sample study to evaluate the accuracy of PBSV3.2 in a pelvic tumor radiotherapy population using the convenient bladder scanner PBSV3.2 made in China. PBSV3.2 provides an acceptable indicator for monitoring bladder volume in patients with pelvic radiotherapy. It is recommended to monitor bladder volume with PBSV3.2 when the planned bladder volume is 200-400ml. For male and patients ≥ 65 years old, at least two repeat measurements are required when using a bladder scanner and the volume should be corrected by using a modified feature to improve bladder volume consistency.
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Affiliation(s)
- Fei Bai
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, China
| | - Qiuxia Hu
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, China
| | - Xiaowei Yao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, China
| | - Ming Cheng
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, China
| | - Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, China.
| | - Linlin Xu
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, China.
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Chauhan K, Ebner DK, Tzou K, Ryan K, May J, Kaleem T, Miller D, Stross W, Malouff TD, Landy R, Strong G, Herchko S, Serago C, Trifiletti DM, Miller RC, Buskirk S, Waddle MR. Assessment of bladder filling during prostate cancer radiation therapy with ultrasound and cone-beam CT. Front Oncol 2023; 13:1200270. [PMID: 37588094 PMCID: PMC10426376 DOI: 10.3389/fonc.2023.1200270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023] Open
Abstract
Prostate cancer patients undergoing external beam radiation therapy (EBRT) benefit from a full bladder to decrease bowel and bladder toxicity. Ultrasound may offer a proxy metric for evaluation, sparing CBCT dosing. Patients were prospectively enrolled pre-simulation from January 2017 to February 2018. Bladder volume was evaluated prior to RT using US daily and CBCT for three daily treatments and then weekly unless otherwise indicated. 29 patients completed median 40 days of RT, resulting in 478 CBCT and 1,099 US bladder volumes. 21 patients were treated to intact glands and 8 to the post-prostatectomy bed. Median patient age was 70 years. Bladder volume on CBCT and US positively correlated (r = 0.85), with average bladder volume for all patients of 162 mL versus 149 mL, respectively. Bladder volume during treatment was consistently lower than the volume at CT simulation (153 mL vs 194 mL, p<0.01) and progressively declined during treatment. Patients older than 70 years presented with lower average bladder volumes than those < 70 years (122 mL vs 208 mL, respectively, p<0.01). Patients with the highest agreement between CBCT and US (<10% variability) had higher average bladder volumes (192 mL vs 120 mL, p=0.01). US was found to be an accurate measure of bladder volume and may be used to monitor daily bladder volumes in patients being treated with radiation for prostate cancer.
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Affiliation(s)
- Kiran Chauhan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Daniel K. Ebner
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Katherine Tzou
- Department of Radiation Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Karen Ryan
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Jackson May
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Tasmeem Kaleem
- Department of Radiation Oncology, Trihealth System, Cincinnati, OH, United States
| | - Daniel Miller
- Department of Radiation Oncology, Gamma West Cancer Center, Idaho Falls, ID, United States
| | - William Stross
- Department of Radiation Oncology, United States Department of Veterans Affairs, Minneapolis, MN, United States
| | - Timothy Dean Malouff
- Department of Radiation Oncology, College of Medicine, University of Oklahoma, Oklahoma City, OK, United States
| | - Robin Landy
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Gerald Strong
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Steve Herchko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Chris Serago
- Department of Therapeutic Radiology, School of Medicine, Yale University, New Haven, CT, United States
| | | | - Robert Clell Miller
- Department of Radiation Oncology, University of Tennessee Medical Center, Knoxville, TN, United States
| | - Steven Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Mark R. Waddle
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
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Béasse A, Boisbouvier S. [Benefits and limitations of using a portable ultrasound scanner (bladderscan) in pelvic radiotherapy. Narrative review of the literature]. Cancer Radiother 2023; 27:259-265. [PMID: 37088573 DOI: 10.1016/j.canrad.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 04/25/2023]
Abstract
PURPOSE The reproducibility of bladder filling influences the target volume position for pelvis radiotherapy. The objective of this study was to summarize the current knowledge on the use of portable echograph systems named Bladderscan (BS) in this context. MATERIAL AND METHODS Review of the PubMed and Google Scholar publication databases was performed between September 2020 and April 2021. Results of this research were filtered in accordance to a set of eligibility criterias and are presented in this article. RESULTS Keyword search yielded a total of 2407 publications, which filtered down to 10 relevant articles in accordance to the eligibility criterias. These publications described the viability of the BS measures as well as their clinical and organizational repercussions. CONCLUSION According to multiple studies, BS allows to measure the bladder volume before each radiotherapy session. The use of BS decreases the amount of Cone Beam Computer Tomography potentially rejected due to non-conformed bladder filling, and improve the throughput of patients.
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Affiliation(s)
- A Béasse
- Fondation Cognacq-Jay, hôpital Forcilles, département de radiothérapie, Lieu-dit Forcilles, 77150 Férolles-Attilly, France.
| | - S Boisbouvier
- Centre de lutte contre le cancer, centre Léon-Bérard, département de radiothérapie, 28, Promenade Léa et Napoléon Bullukian, 69008 Lyon, France.
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5
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Wang Y, Zhu Y, Xu X. Advances in the management of radiation-induced cystitis in patients with pelvic malignancies. Int J Radiat Biol 2023; 99:1307-1319. [PMID: 36940182 DOI: 10.1080/09553002.2023.2181996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Radiotherapy plays a vital role as a treatment for malignant pelvic tumors, in which the bladder represents a significant organ at risk involved during tumor radiotherapy. Exposing the bladder wall to high doses of ionizing radiation is unavoidable and will lead to radiation cystitis (RC) because of its central position in the pelvic cavity. Radiation cystitis will result in several complications (e.g. frequent micturition, urgent urination, and nocturia) that can significantly reduce the patient's quality of life and in very severe cases become life-threatening. METHODS Existing studies on the pathophysiology, prevention, and management of radiation-induced cystitis from January 1990 to December 2021 were reviewed. PubMed was used as the main search engine. Besides the reviewed studies, citations to those studies were also included. RESULTS AND DISCUSSIONS In this review, the symptoms of radiation cystitis and the mainstream grading scales employed in clinical situations are presented. Next, preclinical and clinical research on preventing and treating radiation cystitis are summarized, and an overview of currently available prevention and treatment strategies as guidelines for clinicians is provided. Treatment options involve symptomatic treatment, vascular interventional therapy, surgery, hyperbaric oxygen therapy (HBOT), bladder irrigation, and electrocoagulation. Prevention includes filling up the bladder to remove it from the radiation field and delivering radiation based on helical tomotherapy and CT-guided 3D intracavitary brachytherapy techniques.
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Affiliation(s)
- Yimin Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoting Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Smith L, Gittins J, Ramnarine KV, Chung EML. Assessment of an ultrasound bladder scanner in prostate radiotherapy: A validation study and analysis of bladder filling variability. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:36-43. [PMID: 35173777 PMCID: PMC8841937 DOI: 10.1177/1742271x21995217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION During prostate radiotherapy treatment, it is important to ensure the position of the bladder and prostate is consistent between treatments. The aim of this study was to provide a quantitative basis for incorporating ultrasound bladder volume estimates into local practice for prostate radiotherapy. METHODS Agreement between bladder volume estimates obtained using computed tomography (CT) and ultrasound was assessed. Analysis of bladder volumes between planning and treatment scans was used to quantify expected variations in bladder volume over the course of radiotherapy. Dose-volume statistics were estimated and compared to planned dose constraints to propose a target bladder volume and tolerance. RESULTS Bladder volume measurements were obtained from 19 radiotherapy patients using ultrasound and CT. Ultrasound underestimated bladder volume compared to CT with a mean bias of -28 ± 30 ml. Pre-treatment (planning) bladder volumes varied from 71 to 383 ml with a mean of 200 ml. Treatment bladder volumes reduced by more than half in 9% of patients during the course of their treatment, potentially leading to a 30% increase in mean bladder dose. Patients with pre-treatment bladder volumes < 200 ml were most likely to exhibit differences in bladder volume, resulting in 'out of tolerance' increases in dose. CONCLUSIONS A pragmatic individualised drinking protocol, aimed at achieving a minimum ultrasound bladder volume of 200 ml at planning CT, may be beneficial to reproducibility in radiotherapy treatment. Ultrasound measurements prior to treatment should ideally confirm that bladder volume is at least half the volume measured at planning.
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Affiliation(s)
- L Smith
- Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK,Laura Smith, University Hospital Southampton NHS Foundation Trust, Southampton Oncology Centre, Southampton, SO16 6YD, UK.
| | - J Gittins
- Radiotherapy Physics Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - KV Ramnarine
- Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - EML Chung
- Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Dower K, Ford A, Sandford M, Doherty A, Greenham S, Kerin L, Dwyer P, Hansen C, Westhuyzen J, Shakespeare T. Retrospective evaluation of planning margins for patients undergoing radical radiation therapy treatment for bladder cancer using volumetric modulated arc therapy and cone beam computed tomography. J Med Radiat Sci 2021; 68:371-378. [PMID: 34288566 PMCID: PMC8656189 DOI: 10.1002/jmrs.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 06/20/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Current contouring guidelines for curative radiation therapy for muscle-invasive bladder cancer (MIBC) recommend margins of 1.5-2.0 cm, applied to the clinical target volume (CTV). This study assessed whether the use of volumetric modulated arc therapy (VMAT), cone beam computed tomography (CBCT) and strict bladder preparation allowed for a reduced planning target volume (PTV) expansion, resulting in lower doses to surrounding organs at risk (OARs). METHODS Daily CBCT images for 12 patients (382 scans total) were retrospectively reviewed against four potential PTV margins created on and exported with the reference CT scan. To form the PTVs, three isotropic expansions of 0.5, 1.0 and 1.5 cm were applied to the CTV, as well as an anisotropic expansion of 1.5 cm superiorly and 1.0 cm in all other dimensions. Following treatment completion, the CBCTs were visually assessed to determine the margins encapsulating the bladder. For retrospective planning purposes, the 1.0-cm and anisotropic margins were compared with the previously recommended margins to determine differences in OAR doses. RESULTS The 0.5-, 1.0- and 1.5-cm isotropic margins (IM) and the anisotropic margin (ANIM) covered the CTV in 46.1, 96.8, 100 and 100% of CBCTs retrospectively. Doses to OARs were significantly lower for the reduced margin plans for the small bowel, rectum and sigmoid. CONCLUSION Bladder planning target volumes may be safely reduced. We endorse a PTV margin of 1.0cm anteriorly, posteriorly and inferiorly with 1.0-1.5 cm superiorly for radical whole bladder cases using strict bladder preparation, VMAT and pretreatment CBCTs.
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Affiliation(s)
- Kathleene Dower
- Northern NSW Cancer InstituteLismoreNew South WalesAustralia
| | - Andriana Ford
- Northern NSW Cancer InstituteLismoreNew South WalesAustralia
| | - Michael Sandford
- Mid North Coast Cancer Institute Coffs HarbourCoffs HarbourNew South WalesAustralia
| | - Andrew Doherty
- Mid North Coast Cancer Institute Coffs HarbourCoffs HarbourNew South WalesAustralia
| | - Stuart Greenham
- Mid North Coast Cancer Institute Coffs HarbourCoffs HarbourNew South WalesAustralia
| | - Luke Kerin
- Mid North Coast Cancer Institute Port MacquariePort MacquarieNew South WalesAustralia
| | - Patrick Dwyer
- Northern NSW Cancer InstituteLismoreNew South WalesAustralia
| | - Carmen Hansen
- Mid North Coast Cancer Institute Port MacquariePort MacquarieNew South WalesAustralia
| | - Justin Westhuyzen
- Mid North Coast Cancer Institute Coffs HarbourCoffs HarbourNew South WalesAustralia
| | - Thomas Shakespeare
- Mid North Coast Cancer Institute Coffs HarbourCoffs HarbourNew South WalesAustralia
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Chen HH, Lin PT, Kuo LT, Lin KS, Fang CC, Chi CC. Bladder volume reproducibility after water consumption in patients with prostate cancer undergoing radiotherapy: A systematic review and meta-analysis. Biomed J 2021; 44:S226-S234. [PMID: 35300945 PMCID: PMC9068550 DOI: 10.1016/j.bj.2020.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/29/2020] [Accepted: 11/02/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To minimize toxicity due to radiotherapy in patients with prostate cancer, high bladder volume reproducibility is essential. Water consumption is often used to increase bladder volume reproducibility, but the optimal amount of water required to be consumed remains unclear. We aimed to analyzed the relationship between water consumption and bladder volume reproducibility in patients undergoing radiotherapy for prostate cancer. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials and cohort studies that assessed bladder volume change after water consumption in patients with prostate cancer undergoing radiotherapy. MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for relevant studies published from database inception up until July 4, 2020. The Newcastle-Ottawa Scale was used to evaluate the risk of bias in the included studies. The outcome was the mean difference (MD) of bladder volume after water consumption, evaluated through meta-analysis using a random-effects model. RESULTS Ten cohort studies and one randomized controlled trial with a total of 417 patients were included. For 300-400 ml water consumption, the bladder volume MD between during treatment and at computer tomography-simulation (95% confidence interval [CI]) was -11.97 (-51.68 to 27.74), was -45.99 (-82.85 to -9.13) for 500-540 ml water consumption and -45.92 (-78.86 to -12.98) for water consumption until full-bladder sensation was reached. CONCLUSION Consuming 300-400 ml of water potentially leads to the best bladder volume reproducibility; moreover, the higher the water consumption volume, the lower the bladder volume reproducibility.
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Affiliation(s)
- Hsiao-Hsuan Chen
- Department of Radiation Therapy, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan; Center for Evidence-Based Medicine, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Pei-Tzu Lin
- Center for Evidence-Based Medicine, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan; Department of Pharmacy, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Liang-Tseng Kuo
- Center for Evidence-Based Medicine, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Kun-Sheng Lin
- Department of Radiation Therapy, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Chiung-Chen Fang
- Department of Radiation Therapy, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Kuo DY, Hsu CY, Wang WC, Chen HH, Shueng PW. BladderScan Feedback Method in Predicting Bladder Filling for Prostate Radiotherapy: A Prospective Study. Technol Cancer Res Treat 2021; 20:1533033821995277. [PMID: 33706617 PMCID: PMC7958163 DOI: 10.1177/1533033821995277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Approximately 5%–10% of men who receive prostate cancer radiotherapy will
suffer from radiation cystitis. Bladder filling before the administration of
radiotherapy results in lower radiation exposure to the bladder.
BladderScan, an ultrasound-based bladder volume scanner, has the potential
to evaluate bladder volume during radiotherapy; thus, a prospective pilot
study was initiated. Methods: Eleven men receiving tomotherapy for localized prostate cancer were enrolled.
The validity of BladderScan was evaluated by comparing the measurements from
BladderScan with the calculated volume from megavoltage computed tomography
(MVCT). With a crossover design to compare different methods in bladder
filling, the radiotherapy was divided into 2 sequences. Conventional method:
the patient was asked to drink water after voiding urine. The amount of
water and the duration of waiting were the same as in the setting of the
simulation. BladderScan feedback method: the bladder filling procedure
depended on the BladderScan measurements. Results: There were 314 sets of data from 11 patients. The correlation coefficient
between VBS and VCT was 0.87, where VBS is
the mean volume of 3 measurements by BladderScan and VCT is the
bladder volume derived from MVCT. The BladderScan feedback method resulted
in a significant larger bladder volume than the conventional method, with a
mean difference of 36.9 mL. When the failure was defined as VCT
<80% of planned volume, the BladderScan feedback method brought about a
relative reduction in the failure rate with an odds ratio of 0.44 and an
absolute reduction of 9.1%. Conclusion: The accuracy of BladderScan was validated by MVCT in our study. The
BladderScan feedback method can help patients fill the bladder adequately,
with a larger bladder volume and a lower failure rate.
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Affiliation(s)
- Deng-Yu Kuo
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chen-Yang Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.,Dachung Hospital, Miaoli, Taiwan
| | - Wei-Chun Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Nasser NJ, Fenig E, Klein J, Agbarya A. Maintaining consistent bladder filling during external beam radiotherapy for prostate cancer. Tech Innov Patient Support Radiat Oncol 2021; 17:1-4. [PMID: 33553698 PMCID: PMC7851838 DOI: 10.1016/j.tipsro.2021.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 12/03/2022] Open
Abstract
Radiation for prostate cancer is preferably provided with a full urinary bladder. There are discrepancies how well current methods achieve consistent bladder filling. A urinary catheter with a check-valve controlled by a float is under development.
Radiation therapy for patients with prostate cancer is preferably provided with a full urinary bladder. Full bladder can potentially move the small intestine out of the radiation treatment regions, and results in decreased small bowel radiation dose and gastrointestinal toxicity. Maintaining consistent bladder filling during computerized tomography simulation scan used for treatment planning and at daily radiation treatments is challenging. Here we present an in-development urinary catheter with a floating balloon that drains the bladder only when urine reaches to a prespecified level, and review current methods used in clinic to ensure consistent bladder filling. These includes bladder filling protocols, ultrasound scanning and biofeedback techniques.
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Affiliation(s)
- Nicola J. Nasser
- Department of Radiation Oncology, University of Maryland School of Medicine, Maryland Proton Treatment Center, Baltimore, MD, USA
- Corresponding author at: University of Maryland School of Medicine, Department of Radiation Oncology, Maryland Proton Treatment Center, Baltimore, MD, USA.
| | - Eyal Fenig
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Jonathan Klein
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Abed Agbarya
- Institute of Oncology, Bnai Zion Medical Center, Haifa, Israel
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11
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王 皓, 姜 树, 彭 冉, 黄 毅, 王 明, 王 俊, 刘 承, 张 帆, 马 潞. [Individual control of urine volume to improve stability of bladder volume in radiotherapy of urinary tumor]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:688-691. [PMID: 32773802 PMCID: PMC7433637 DOI: 10.19723/j.issn.1671-167x.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the training mode of individual urine volume control, to take indi-vidual expected urine volume as the goal of bladder control in patients with urinary system tumors, and to improve the accuracy of bladder control during radiotherapy by active training of bladder receptivity. METHODS Twenty-five patients of urinary system tumors were enrolled from May 2019 to September 2019, of whom, 21 patients had prostate cancer, and 4 had bladder cancer. Training of bladder filling started before CT simulation. The patients were required to take the individual bladder filling as the training goal, and the optimal bladder volume range was suggested to be 200-400 mL. After 2-4 weeks of training, the prescribed volume of the bladder was determined according to the patient's bladder receptivity. The volume of the bladder was measured by images of plain CT and images 8-minutes after intravenous contrast injection. The patient's bladder volume was measured using BladderScan before treatment. CBCT (Cone-beam CT) was performed, and bladder volume was measured before treatment. The bladder volume was measured again using BladderScan after treatment. RESULTS The mean bladder volume of simulation (VCT01) was (262±130) mL, ranging from 78 mL to 505 mL. The mean self-evaluation bladder volume before radiotherapy (VEVA01) was (238±107) mL, ranging from 100 mL to 400 mL. The mean BladderScan measured volume before radiotherapy (VBVI01) was (253±123) mL, ranging from 60 mL to 476 mL. The mean cone-beam CT measured volume before radiotherapy (VCBCT) was (270±120) mL, ranging from 104 mL to 513 mL. There was a correlation between VEVA01 and VBVI01, VCT01 and VBVI01, VCT01, and VBVI01, and there was no significant difference in paired t-test. There was a correlation between differences of self-evaluation bladder volume before radiotherapy(VEVA01) and simulation CT (VCT01) and differences of self-evaluation bladder volume before radiotherapy (VEVA01) and cone-beam CT (VCBCT), and there was no significant difference in paired samples by t-test. CONCLUSION During radiotherapy for urinary system tumors, such as prostate cancer and bladder cancer, with the assistance of BladderScan, the patients could try to hold their urine moderately according to their conditions, and individualized bladder prescription may be beneficial to achieve stable bladder volume during radiotherapy.
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Affiliation(s)
- 皓 王
- 北京大学第三医院肿瘤放疗科,北京 100191Department of Radiation Oncology
| | - 树坤 姜
- 北京大学第三医院肿瘤放疗科,北京 100191Department of Radiation Oncology
| | - 冉 彭
- 北京大学第三医院肿瘤放疗科,北京 100191Department of Radiation Oncology
| | - 毅 黄
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 明清 王
- 北京大学第三医院肿瘤放疗科,北京 100191Department of Radiation Oncology
| | - 俊杰 王
- 北京大学第三医院肿瘤放疗科,北京 100191Department of Radiation Oncology
| | - 承 刘
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 帆 张
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 潞林 马
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
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12
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Overview of patient preparation strategies to manage internal organ motion during radiotherapy in the pelvis. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Pelvic internal organs change in volume and position during radiotherapy. This may compromise the efficacy of treatment or worsen its toxicity. There may be limitations to fully correcting these changes using online image guidance; therefore, effective and consistent patient preparation and positioning remain important. This review aims to provide an overview of the extent of pelvic organ motion and strategies to manage this motion.Methods and Materials:Given the breadth of this topic, a systematic review was not undertaken. Instead, existing systematic reviews and individual high-quality studies addressing strategies to manage pelvic organ motion have been discussed. Suggested levels of evidence and grades of recommendation for each strategy have been applied.Results:Various strategies to manage rectal changes have been investigated including diet and laxatives, enemas and rectal emptying tubes and rectal displacement with endorectal balloons (ERBs) and rectal spacers. Bladder-filling protocols and bladder ultrasound have been used to try to standardise bladder volume. Positioning the patient supine, using a full bladder and positioning prone with or without a belly board, has been examined in an attempt to reduce the volume of irradiated small bowel. Some randomised trials have been performed, with evidence to support the use of ERBs, rectal spacers, bladder-filling protocols and the supine over prone position in prostate radiotherapy. However, there was a lack of consistent high-quality evidence that would be applicable to different disease sites within the pelvis. Many studies included small numbers of patients were non-randomised, used less conformal radiotherapy techniques or did not report clinical outcomes such as toxicity.Conclusions:There is uncertainty as to the clinical benefit of many of the commonly adopted interventions to minimise pelvic organ motion. Given this and the limitations in online image guidance compensation, further investigation of adaptive radiotherapy strategies is required.
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Metzger A, Renz P, Hasan S, Karlovits S, Sohn J, Gresswell S. Unforeseen Computed Tomography Resimulation for Initial Radiation Planning: Associated Factors and Clinical Impact. Adv Radiat Oncol 2019; 4:716-721. [PMID: 31673665 PMCID: PMC6817516 DOI: 10.1016/j.adro.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 12/04/2022] Open
Abstract
Purpose Repeat computed tomography (CT) simulation is problematic because of additional expense of clinic resources, patient inconvenience, additional radiation exposure, and treatment delay. We investigated the factors and clinical impact of unplanned CT resimulations in our network. Methods and Materials We used the billing records of 18,170 patients treated at 5 clinics. A total of 213 patients were resimulated before their first treatment. The disease site, location, use of 4-dimensional CT (4DCT), contrast, image fusion, and cause for resimulation were recorded. Odds ratios determined statistical significance. Results Our total rate of resimulation was 1.2%. Anal/colorectal (P < .001) and head and neck (P < .001) disease sites had higher rates of resimulation. Brain (P = .001) and lung/thorax (P = .008) had lower rates of resimulation. The most common causes for resimulation were setup change (11.7%), change in patient anatomy (9.8%), and rectal filling (8.5%). The resimulation rate for 4DCTs was 3.03% compared with 1.0% for non-4DCTs (P < .001). Median time between simulations was 7 days. Conclusions The most common sites for resimulation were anal/colorectal and head and neck, largely because of change in setup or changes in anatomy. The 4DCT technique correlated with higher resimulation rates. The resimulation rate was 1.2%, and median treatment delay was 7 days. Further studies are warranted to limit the rate of resimulation.
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Affiliation(s)
- April Metzger
- Division of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
- Corresponding author.
| | - Paul Renz
- Division of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Shaakir Hasan
- Division of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Stephen Karlovits
- Division of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Jason Sohn
- Division of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Steven Gresswell
- Division of Radiation Oncology, Keesler Air Force Base, Biloxi, Mississippi
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Grün A, Kawgan-Kagan M, Kaul D, Badakhshi H, Stromberger C, Budach V, Böhmer D. Impact of bladder volume on acute genitourinary toxicity in intensity modulated radiotherapy for localized and locally advanced prostate cancer. Strahlenther Onkol 2018; 195:517-525. [PMID: 30443682 DOI: 10.1007/s00066-018-1398-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the effect of changes in bladder volume during high-dose intensity-modulated-radiotherapy (IMRT) of prostate cancer on acute genitourinary (GU) toxicity and prospectively evaluate a simple biofeedback technique for reproducible bladder filling with the aim of reducing acute GU toxicity. METHODS One hundred ninety-three patients were trained via a biofeedback mechanism to maintain a partially filled bladder with a reproducible volume of 200-300 cc at planning CT and subsequently at each fraction of radiotherapy. We prospectively analyzed whether and to what extent the patients' ability to maintain a certain bladder filling influenced the degree of acute GU toxicity and whether cut-off values could be differentiated. RESULTS We demonstrated that the ability to reach a reproducible bladder volume above a threshold volume of 180 cc and maintain that volume via biofeedback throughout treatment predicts for a decrease in acute GU toxicity during curative high-dose IMRT of the prostate. Patients who were not able to reach a partial bladder filling to that cut-off value and were not able to maintain a partially filled bladder throughout treatment had a significantly higher risk of developing ≥grade 2 GU acute toxicity. CONCLUSION Our results support the hypothesis that a biofeedback training for the patient is an easy-to-apply, useful, and cost-effective tool for reducing acute GU toxicity in high-dose IMRT of the prostate. Patients who are not able to reach and maintain a certain bladder volume during planning and treatment-two independent risk factors-might need special consideration.
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Affiliation(s)
- Arne Grün
- Department for Radiation Oncology, Charité-University Medicine Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Michael Kawgan-Kagan
- Department for Radiation Oncology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - David Kaul
- Department for Radiation Oncology, Charité-University Medicine Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Harun Badakhshi
- Department for Radiation Oncology, Ernst-von-Bergmann Klinikum, Charlottenstraße 72, 14467, Potsdam, Germany
| | - Carmen Stromberger
- Department for Radiation Oncology, Charité-University Medicine Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Volker Budach
- Department for Radiation Oncology, Charité-University Medicine Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dirk Böhmer
- Department for Radiation Oncology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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Nathoo D, Loblaw A, Davidson M, Musunuru HB, Khojaste A, Ravi A. A Feasibility Study on the Role of Ultrasound Imaging of Bladder Volume as a Method to Improve Concordance of Bladder Filling Status on Treatment with Simulation. J Med Imaging Radiat Sci 2018; 49:277-285. [PMID: 32074054 DOI: 10.1016/j.jmir.2018.04.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/12/2018] [Accepted: 04/20/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Accurate positioning of the prostate is of paramount importance to ensure optimal target coverage and normal tissue sparing in stereotactic ablative body radiation when large doses per fraction are delivered with tight margins around the prostate. Bladder and rectal filling play an important part in controlling the accuracy of a patient's setup and therefore the overall toxicities and outcomes. The aim of this study was to establish the value of characterizing patients' bladder filling kinetics at the time of simulation with ultrasound scans so that a predictive model can be used to ensure that a bladder volume at treatment would match at simulation. METHODS A prospective trial was conducted in unfavorable risk prostate cancer patients to evaluate the utility of ultrasound bladder monitoring. Thirty patients (n = 30) were enrolled in this study. Patients were required to void before simulation and then were given 500 mL of fluids to drink. Ultrasound measurements of the bladder were documented at 15-minute intervals for up to four measurements before simulation. On treatment, bladder volumes were measured at a single time point; typically, half an hour after the patient voided and consumed 500 mL of fluids. The kinetic model was then used to predict the optimal time to set up the patient for treatment such that the bladder volume at treatment would match the volume at simulation. Every patient had a cone beam computed tomography scan before each fraction to ensure accurate patient positioning before dose delivery. Bladder volumes at treatment were measured and compared with those at simulation on the cone beam computed tomography data sets using MIMVISTA software. RESULTS Of 30 patients, 26 were analyzed. The comparison of the bladder contours at treatment compared to simulation yielded a DICE coefficient (similarity) of 0.76 ± 0.11. The largest variation in bladder size was seen in the anterior-posterior direction. CONCLUSIONS This study demonstrated that ultrasound monitoring of the bladder status was a valuable tool in ensuring reproducible bladder filling on treatment. The bladder kinetic model indicated the general time required to achieve optimal bladder filling was 60 minutes after voiding and drinking 500 mL of water.
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Affiliation(s)
- Dilshad Nathoo
- Department of Radiation Therapy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Davidson
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hima Bindu Musunuru
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Amir Khojaste
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ananth Ravi
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Hysing LB, Ekanger C, Zolnay Á, Helle SI, Rasi M, Heijmen BJ, Sikora M, Söhn M, Muren LP, Thörnqvist S. Statistical motion modelling for robust evaluation of clinically delivered accumulated dose distributions after curative radiotherapy of locally advanced prostate cancer. Radiother Oncol 2018; 128:327-335. [DOI: 10.1016/j.radonc.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 05/16/2018] [Accepted: 06/04/2018] [Indexed: 12/25/2022]
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Cramp L, Connors V, Wood M, Westhuyzen J, McKay M, Greenham S. Use of a prospective cohort study in the development of a bladder scanning protocol to assist in bladder filling consistency for prostate cancer patients receiving radiation therapy. J Med Radiat Sci 2016; 63:179-85. [PMID: 27648282 PMCID: PMC5016618 DOI: 10.1002/jmrs.162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Evidence of variations in bladder filling effecting prostate stability and therefore treatment and side-effects is well established with intensity modulated radiation therapy (IMRT). This study aimed to increase bladder volume reproducibility for prostate radiation therapy by implementing a bladder scanning (BS) protocol that could assist patients' bladder filling at computed tomography (CT) simulation and treatment. METHODS Based on a retrospective review of 524 prostate cancer patients, a bladder volume of 250-350 mL was adopted as 'ideal' for achieving planning dose constraints. A prospective cohort study was conducted to assess the clinical utility of measuring patients' bladder volumes at CT simulation using an ultrasound bladder scanner (Verathon 9400 BladderScan(®)). A revised bladder preparation protocol was utilised by a bladder scan group (BS) and a non-BS group followed the standard departmental bladder preparation protocol. Time and volume data for the BS group (n = 17) were compared with the non-BS group (n = 17). RESULTS The BS cohort had a CT bladder volume range of 221-588 mL; mean 379 mL, SD 125 mL. The non-BS group had a larger range: 184-757 mL; mean 373 mL, SD 160 mL (P = 0.9171). There was a positive correlation between CT volume and BS volume in the BS group (r = 0.797; P = 0.0002) although BS volumes were smaller: range 160-420 mL; mean 251 mL; SD 91 mL; P < 0.0001). The maximum bladder volume receiving 50 Gy (V50) from the BS group was 46.4%, mean 24.5%. The maximum bladder V50 from the non-BS group was 50.9%, mean 27.3% (P = 0.5178). Treatment data from weekly cone beam CT scans were also compared over 6 weeks. They were assessed as being a pass if bladder and bowel requirements were acceptable. The BS group proceeded to treatment on the basis of a pass 92.7% of the time, whereas the pass rate for non-BS group was 75%; difference 17.7% (P < 0.0001). CONCLUSION The BS is a useful tool for achieving consistent, appropriately sized bladder volumes in prostate cancer patients.
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Affiliation(s)
- Leah Cramp
- Department of Radiation Oncology North Coast Cancer Institute Coffs Harbour Health Campus Coffs Harbour New South Wales Australia
| | - Vanessa Connors
- Department of Radiation Oncology North Coast Cancer Institute Coffs Harbour Health Campus Coffs Harbour New South Wales Australia
| | - Maree Wood
- Department of Radiation Oncology North Coast Cancer Institute Coffs Harbour Health Campus Coffs Harbour New South Wales Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology North Coast Cancer Institute Coffs Harbour Health Campus Coffs Harbour New South Wales Australia
| | - Michael McKay
- North Coast Cancer Institute Lismore Health Campus Lismore New South Wales Australia
| | - Stuart Greenham
- Department of Radiation Oncology North Coast Cancer Institute Coffs Harbour Health Campus Coffs Harbour New South Wales Australia
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