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Almasaudi AS. A Review of the Efficacy of the Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) Diet in Managing Gastrointestinal Symptoms Related to Cancer Treatment. Cureus 2024; 16:e56579. [PMID: 38646212 PMCID: PMC11027021 DOI: 10.7759/cureus.56579] [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] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, designed to alleviate symptoms in individuals with irritable bowel syndrome (IBS), focuses on limiting the consumption of poorly absorbed fermentable carbohydrates known as FODMAP. These FODMAP are believed to be the primary triggers for food-related gastrointestinal symptoms in functional gastrointestinal disorders. However, there is currently insufficient direct evidence investigating the role of low FODMAP diets in cancer patients undergoing treatment. This review aims to summarize the current evidence on the low FODMAP diet and its potential implications for cancer patients in terms of treatment outcomes, alleviating gastrointestinal symptoms, and overall health. A systematic literature search was conducted using databases, including PubMed, Scopus, Google Scholar, Web of Science, and Cochrane. Five studies met the criteria for inclusion in the review, and these studies covered rectal toxicity during radiotherapy, gastrointestinal symptoms in colorectal cancer patients, acute gastrointestinal toxicity during pelvic external beam radiotherapy, symptoms in patients with radiation-induced enteropathy, and chronic gastrointestinal sequelae resulting from pelvic organ cancer treatment. The available evidence suggests that a low FODMAP diet may offer advantages in reducing rectal gas and volume during radiotherapy, alleviating diarrhea symptoms, reducing symptom deterioration, and improving quality of life. However, these studies highlight the need for large-scale randomized trials, long-term follow-up, and guidelines to establish the efficacy, safety, and implementation strategies of the low FODMAP diet in different cancer contexts and patient populations. While preliminary findings reported some possible benefits of a low FODMAP diet for certain cancer patients, rigorous studies with large sample sizes are needed to provide more robust evidence. Further research is warranted to optimize the utilization of this diet as an adjunctive intervention for managing gastrointestinal symptoms in this population.
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Affiliation(s)
- Arwa S Almasaudi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, SAU
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Holm MO, Bye A, Falkmer U, Tobberup R, Rasmussen HH, Lauridsen C, Yilmaz MK, Søndergaard J, Poulsen LØ. The effect of nutritional interventions in acute radiation-induced diarrhoea in patients with primary pelvic cancer: A systematic review. Crit Rev Oncol Hematol 2023:104038. [PMID: 37236410 DOI: 10.1016/j.critrevonc.2023.104038] [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: 01/02/2023] [Revised: 05/08/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
Acute radiation-induced diarrhoea (RID) is a well-known side effect of external radiation therapy for pelvic cancer. Acute RID is an unresolved clinical problem in approximately 80% of patients. We investigated the effect of nutritional interventions on acute RID in patients with pelvic cancer treated with curative radiotherapy. A search was conducted using PubMed, Embase.com, CINAHL, and Cochrane Library, from 1 January 2005 until 10 October 2022. We included randomised controlled trials or prospective observational studies. Eleven of the 21 identified studies had low quality of evidence, mainly because of low patient numbers distributed among several cancer diagnoses, and non-systematic assessment of acute RID. Interventions included probiotics (n = 6), prebiotics (n = 6), glutamine (n = 4), and others (n = 5). Five studies, of which two provided high quality evidence, showed that probiotics improved acute RID. Future well-designed studies investigating the effects of probiotics on acute RID are warranted. PROSPERO ID: CRD42020209499).
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Affiliation(s)
- Mette Overgaard Holm
- Center for Nutrition and Intestinal Failure, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; National Research Network on Nutrition in Cancer, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Danish Nutrition Science Center, Aalborg University Hospital, Aalborg, Denmark.
| | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ursula Falkmer
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; National Research Network on Nutrition in Cancer, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Randi Tobberup
- Center for Nutrition and Intestinal Failure, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; National Research Network on Nutrition in Cancer, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Danish Nutrition Science Center, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Intestinal Failure, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; National Research Network on Nutrition in Cancer, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Danish Nutrition Science Center, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Lauridsen
- Center for Nutrition and Intestinal Failure, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; National Research Network on Nutrition in Cancer, Denmark; Danish Nutrition Science Center, Aalborg University Hospital, Aalborg, Denmark; Department of Animal and Veterinary Sciences, Aarhus University, Aarhus, Denmark
| | - Mette Karen Yilmaz
- National Research Network on Nutrition in Cancer, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Jimmi Søndergaard
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Laurids Østergaard Poulsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; National Research Network on Nutrition in Cancer, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
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Alexander S, Oelfke U, McNair H, Tree A. GI factors, potential to predict prostate motion during radiotherapy; a scoping review. Clin Transl Radiat Oncol 2023; 40:100604. [PMID: 36936470 PMCID: PMC10020110 DOI: 10.1016/j.ctro.2023.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023] Open
Abstract
Purpose A scoping literature review was conducted to identify gastrointestinal (GI) factors most likely to influence prostate motion during radiotherapy. We proffer that patient specific measurement of these GI factors could predict motion uncertainty during radiotherapy, facilitating personalised care by optimising treatment technique e.g., daily adaption or via bespoke patient pre-habilitation and preparation. Methods The scoping review was undertaken as per JBI guidelines. Searches were conducted across four databases: Ovid Medline®, EMBASE, CINAHL and EBSCO discovery. Articles written in English from 2010-present were included. Those pertaining to paediatrics, biological women exclusively, infectious and post-treatment GI morbidity and diet were excluded.Common GI factors impacting men were identified and related symptoms, incidence and measurement tools examined. Prevalence among persons with prostate cancer was explored and suitable assessment tools discussed. Results A preliminary search identified four prominent GI-factors: mental health, co-morbidity and medication, physical activity, and pelvic floor disorder. The scoping search found 3644 articles; 1646 were removed as duplicates. A further 1249 were excluded after title and abstract screening, 162 remained subsequent to full text review: 42 mental health, 53 co-morbidity and medication, 39 physical activity and 28 pelvic floor disorder.Six GI factors prevalent in the prostate cancer population and estimated most likely to influence prostate motion were identified: depression, anxiety, diabetes, obesity, low physical activity, and pelvic floor disorder. Reliable, quick, and easy to use tools are available to quantify these factors. Conclusion A comprehensive GI factor assessment package suitable to implement into the radiotherapy clinic has been created. Unveiling these GI factors upfront will guide improved personalisation of radiotherapy.
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Affiliation(s)
- S.E. Alexander
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - U. Oelfke
- The Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, United Kingdom
| | - H.A. McNair
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - A.C. Tree
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
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Wada Y, Monzen H, Ishida N, Ri A, Tatsuno S, Uehara T, Inada M, Doi H, Nakamatsu K, Hosono M, Nishimura Y. Impact of rectal gas on the planning target volume margin for pelvic bone and prostate matching in prostate cancer patients receiving volumetric-modulated arc therapy. Med Dosim 2023:S0958-3947(23)00030-4. [PMID: 37080819 DOI: 10.1016/j.meddos.2023.03.009] [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: 12/23/2022] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
We performed daily cone-beam computed tomography (CBCT) to determine the impact of rectal gas on the movements of prostate and seminal vesicles (SVs). We aimed to determine the relationship between planning target volume (PTV) margins and rectal gas. In 30 treatments of 15 prostate cancer patients, excessive rectal gas was removed and CBCT images were analyzed. Image registration between planning CT and daily CBCT images before and after rectal gas removal was performed for pelvic bone and prostate matching. The couch movement distance between each matching was considered the prostate movement. In addition, we measured SV tip movement between each matching. The anterior-posterior movement of the prostate before rectal gas removal (3.1 ± 2.9 mm) was significantly greater than that after rectal gas removal (1.2 ± 1.2 mm; p < 0.01). The left-right and superior-inferior movements were similar regardless of the presence or absence of rectal gas. The SV movement distances before and after rectal gas removal were 11.0 ± 5.8 mm and 4.6 ± 3.8 mm, respectively (p < 0.01), in pelvic bone matching, and 8.0 ± 4.2 mm and 3.8 ± 3.2 mm, respectively (p < 0.01), in prostate matching. After rectal gas removal, the SV position did not differ significantly between each matching. In 26 of the 30 treatments, SV movement distance in the presence of rectal gas was >6 mm, which is the minimum PTV margin at our institution. In comparison, after rectal gas removal and prostate matching, only 6 treatments demonstrated an SV movement distance of >6 mm. In the presence of rectal gas, the SVs require greater PTV margins than the prostate. Rectal gas removal should be considered if the movement distance on prostate matching is greater than the minimum PTV margin at treating institution.
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Affiliation(s)
- Yutaro Wada
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan.
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Naoko Ishida
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Aritoshi Ri
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Saori Tatsuno
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Takuya Uehara
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Masahiro Inada
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Makoto Hosono
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
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Xie H, Gong M, Zhang J, Li Q. Construction of a predictive model for radiation proctitis after radiotherapy for female pelvic tumors based on machine learning. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1065-1074. [PMID: 36097774 PMCID: PMC10950104 DOI: 10.11817/j.issn.1672-7347.2022.220353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Radiation therapy is a main method for female pelvic malignancies, which can cause some adverse reactions, such as radiation proctitis (RP). The incidence of RP is highly positively correlated with radiation dose. There is an urgent need for a scientific method to accurately predict the occurrence of RP to help doctors make clinical decisions. In this study, based on the clinical data of female pelvic tumor patients and dosimetric parameters of radiotherapy, the random forest method was used to screen the hub features related to the occurrence of RP, and then a machine learning algorithm was used to construct a risk prediction model for the occurrence of RP, in order to provide technical support and theoretical basis for the prediction and prevention of RP. METHODS A total of 100 female patients with pelvic tumors, who received static three-dimensional conformal intensity-modulated radiation therapy in the Department of Radiation Oncology of the Affiliated Hospital of Xiangnan University from January 2019 to December 2020, were retrospectively collected, and their clinically relevant data and radiotherapy planning system data were collected. During radiotherapy and 18 months after radiotherapy, 35 cases developed RP (RP group), and the remaining 65 cases had no RP (non-RP group). The clinical and dosimetric characteristics of patients were ranked by the importance of random forest algorithm, and the independent prognostic characteristics associated with the occurrence of RP were selected for machine learning modeling. A total of 6 machine learning algorithms including support vector machines, random forests, logistic regression, lightweight gradient boosting machines, Gaussian naïve Bayes, and adaptive enhancement were used to build models. The performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score. Finally, the random forest model was determined as the prediction model, and the calibration curve and decision curve of the prediction model were drawn to evaluate the accuracy and clinical benefit of the model. RESULTS The parameters for random forest prediction model in the training set were as follow: AUC, 1.000, accuracy, 0.988, sensitivity, 1.000, specificity, 1.000, positive predictive value, 1.000, negative predictive value, 0.981, and F1 score, 1.000. In validation set, AUC was 0.713, accuracy was 0.640, sensitivity was 0.618, specificity was 0.822, positive predictive value was 0.500, negative predictive value was 0.656, and F1 score was 0.440. Random forest showed high predictive performance. Moreover, the Brief of the calibration curve for the prediction model was 0.178, the prediction accuracy was high, and the decision curve showed that the prediction model could benefit clinically. CONCLUSIONS Based on the clinical and dosimetric parameters for the female pelvic tumor patients, the prediction model of radiation proctitis constructed by random forest algorithm has high predictive ability and strong clinical usability.
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Affiliation(s)
- Hui Xie
- Department of Radiation Oncology, Affiliated Hospital of Xiangnan University, Chenzhou Hunan 423000.
- Key Laboratory of Medical Imaging and Artificial Intelligence of Hunan Province, Chenzhou Hunan 423000.
| | - Ming Gong
- Department of Radiation Oncology, Affiliated Hospital of Xiangnan University, Chenzhou Hunan 423000
- School of Nuclear Science and Techology, University of South China, Hengyang Hunan 421001
| | - Jianfang Zhang
- Department of Physical Examination, Beihu Centers for Disease Control and Prevention, Chenzhou Hunan 423000
| | - Qing Li
- Key Laboratory of Medical Imaging and Artificial Intelligence of Hunan Province, Chenzhou Hunan 423000.
- College of Medical Imaging Laboratory and Rehabilitation, Xiangnan University, Chenzhou Hunan 423000, China.
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Ward J, Gill S, Armstrong K, Fogarty T, Tan D, Scott A, Yahya A, Dhaliwal SS, Jacques A, Tang C. Randomised controlled trial on the effect of simethicone bowel preparation on rectal variability during image-guided radiation therapy for prostate cancer (SPoRT study). J Med Imaging Radiat Oncol 2022; 66:866-873. [PMID: 35322563 DOI: 10.1111/1754-9485.13404] [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: 08/26/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to assess whether simethicone reduces the rectal volume (RV) and gas volume (GV), to increase treatment accuracy and to decrease toxicity of prostate radiation therapy. METHODS 30 patients were randomised to simethicone or no intervention. Cone-beam computed tomography (CBCT) scans were performed on Days 1-3 and weekly until completion of radiation. RV and GV were measured using volume delineation. Toxicity data were collected. RESULTS 264 CBCTs were analysed. RV and GV were not significantly different in the simethicone group compared with the control group at each time point (P >0.05) after adjusting for Week 0 values as a covariate. The simethicone group showed an average reduction in RV and GV of 10% and 21%, respectively, compared with the control group (P >0.05). Standard deviations were calculated over 10 time points, which were grouped to represent the first 2-3 weeks of radiation therapy versus subsequent weeks. These were not significantly different between the simethicone and control group. However, there was a statistically significant decrease in the variability of RV at time points 6-10 compared with time points 1-5 within the simethicone group (P = 0.012), but no significant difference was found between these grouped time points in the control group (P = 0.581). The toxicity questionnaires showed no significant difference between the groups. CONCLUSIONS Simethicone did not decrease the RV or GV overall. However, simethicone appeared to significantly decrease the RV variability from Week three onwards. This suggests that taking simethicone two to three weeks before starting radiation therapy may reduce RV variability, although a larger study is needed to confirm this.
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Affiliation(s)
- Jennifer Ward
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,Division of Internal Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Kevin Armstrong
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tamara Fogarty
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Daren Tan
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia
| | - Alison Scott
- Radiation Oncology Medical Physics, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia
| | - Aylin Yahya
- Department of Radiation Oncology, Clinical Trials and Research Unit, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia
| | - Satvinder Singh Dhaliwal
- Department of Radiation Oncology, Clinical Trials and Research Unit, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, George Town, Pulau Pinang, Malaysia
| | - Angela Jacques
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Colin Tang
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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Rowe LS, Mandia JJ, Salerno KE, Shankavaram UT, Das S, Escorcia FE, Ning H, Citrin DE. Bowel and bladder reproducibility in image guided radiation therapy for prostate cancer: Results of a patterns of practice survey. Adv Radiat Oncol 2022; 7:100902. [PMID: 35847548 PMCID: PMC9280021 DOI: 10.1016/j.adro.2022.100902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Optimal management of patients with prostate cancer (PCa) to achieve bowel and bladder reproducibility for radiation therapy (RT) and the appropriate planning target volume (PTV) expansions for use with modern image guidance is uncertain. We surveyed American Society of Radiation Oncology radiation oncologists to ascertain practice patterns for definitive PCa RT with respect to patient instructions and set up, daily image guidance, and subsequent PTV expansions. Methods and Materials A pattern of practice survey was sent to American Society of Radiation Oncology radiation oncologists who self-identified as specializing in PCa. Respondents identified the fractionation regimens routinely used, and their practices regarding diet, bowel, and bladder instructions for patients with PCa before RT simulation and throughout treatment. Questions regarding PTV margins, daily set up practices, and use of image guidance were included. Results Of 190 respondents, 158 reported using conventional fractionation (CFx), 49 moderate hypofractionation (MHFx), and 61 stereotactic body radiation therapy (SBRT). Diet modifications during RT were advised by 84% of respondents, treatment with full bladder by 96%, and bowel instructions by 78%. Prescription of bowel medication was higher for respondents using SBRT (95.1%) versus those using CFx/MHFx (55.1%; 34.7%). The most common implantable device reported was fiducial markers, with increased use in SBRT (86.0%; 68.9%) versus CFx/MHFx. Cone beam computed tomography was the most common daily imaging technique across fractionation regimens. SBRT showed correlation between PTV margin expansions, fiducial marker use, and image guidance. Conclusions Survey results indicate heterogeneity in treatment modality, dose, patient instructions, and PTV expansions used by radiation oncologists in the treatment of patients with PCa. Further investigation to define appropriate patient instructions on bowel preparation to maximize target reproducibility in PCa is needed, as is continued guidance on evidence-based approaches for image guidance and PTV margin selection.
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Goddard L, Jeong K, Tomé WA. Commissioning and routine quality assurance of the radixact synchrony system. Med Phys 2021; 49:1181-1195. [PMID: 34914846 DOI: 10.1002/mp.15410] [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: 06/18/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The Radixact Synchrony system allows for target motion correction when tracking either fiducials in/around the target or a dense lesion in the lung. As such evaluation testing and Quality Assurance (QA) tests are required. METHODS To allow for QA procedures to be performed with a range of available phantoms evaluation of the dosimetric delivery accuracy was performed for a range of motions, phantoms and motion platforms. A CIRS 1D motion platform and Accuray Tomotherapy "cheese" phantom was utilized to perform absolute dose and EBT3 film measurements. A HexaMotion platform and Delta4 phantom were utilized to quantify the effects of 1D and 3D motions. Inter-device comparison was performed with the ArcCHECK and Delta4 phantoms and GafChromic film, five patient plans were delivered to each phantom when static and with two different motion types both with and without Synchrony motion correction. RESULTS A range of QA tests are described. A phantom was designed to allow for daily verification of system functionality. This test allows for detection of either fiducials or a dense silicone target with a stationary phantom. Monthly testing procedures are described that allow the user to verify the dosimetric improvement when utilizing synchrony delivery motion compensation vs. uncorrected motions. These can be performed utilizing a 1D motion stage with an ion-chamber and GafChromic film to allow for a 2D dosimetric validation. Alternatively, a 3D motion platform can be utilized where available. Monthly and annual imaging tests are described. Finally, annual test procedures designed to verify the coincidence of the imaging system and treatment isocenter are described. Evaluation of the Synchrony system using a range of QA devices shows consistently high dosimetric accuracy with similar trends in passing criteria found with GafChromic film, ArcCHECK and Delta4 phantoms for density based respiratory model compensation. CONCLUSION These results highlight the large improvements in the dose distribution when motion is accounted for with the Synchrony system as measured with a range of phantoms and motion platforms that the majority of users will have available. The testing methods and QA procedures described provide guidance for new users of the Radixact Synchrony system as they implement their own quality assurance programs for this system, until such time as an AAPM task group report is made available. QA procedures including kV imaging quality metrics and imaging dose parameters, dose deposition accuracy, target detection coincidence and target position detection accuracy are described. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lee Goddard
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Kyoungkeun Jeong
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Wolfgang A Tomé
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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