The influence of a rectal balloon tube as internal immobilization device on variations of volumes and dose-volume histograms during treatment course of conformal radiotherapy for prostate cancer.
OBJECTIVE
A prospective comparative study of a subset of 10 consecutive patients was performed, to describe the effects of an air-inflated rectal balloon tube that has been used for prostate immobilization in 360 patients since 1994. In particular, influences on prostate motion, rectum filling variations, and dose-volume histograms (DVHs) of the rectum during a course of conformal radiotherapy were investigated.


METHODS
Computed tomographic (CT) examinations without and with rectal balloon (filled with 40 mL air) were performed at the start (t(0)), middle (t(mi)), and end of treatment (t(e)), resulting in 6 CT scans for each patient. Prostate displacement was measured from a lateral beam's-eye-view. DVHs of rectum as a solid organ, and anterior, posterior, and whole rectum wall were calculated at t(0), t(mi), and t(e), and variations during treatment were analyzed for both examinations, with and without balloon.


RESULTS
By use of the balloon, rectum filling variations (p = 0.04) and maximum anterior-posterior displacements of the prostate (p = 0.008) were reduced significantly, leading to a reduction in DVH variations during treatment. Maximum displacements of posterior prostate border (>5 mm) were found in 8/10 patients without a rectum balloon and in only 2/10 patients with the balloon. The balloon led to a significant reduction in partial posterior rectal wall volumes included in the high-dose regions, without significant changes at the anterior rectum wall in cases of irradiation of the prostate only. However, when entirely irradiating the whole seminal vesicles, this advantage was lost.


CONCLUSIONS
The rectal balloon catheter represents a simple technique to immobilize the prostate and to determine the position of the anterior rectal wall at daily treatment. This allows a reduction of margins, because of reduced prostate movement during treatment course.
Wachter
Stefan
S
Department of Radiotherapy and Radiobiology, Vienna General Hospital, University of Vienna Medical School, Vienna, Austria. stefan.wachter@akh-wien.ac.at
Gerstner
Natascha
N
Dorner
Daniela
D
Goldner
Gregor
G
Colotto
Adriana
A
Wambersie
Andre
A
Pötter
Richard
R
D002404:Catheterization / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007103:Immobilization; D008297:Male; D011446:Prospective Studies; D011467:Prostate; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011829:Radiation Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D012007:Rectum / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D012669:Seminal Vesicles; D014057:Tomography, X-Ray Computed