title: The impact of varying volumes in rectal balloons on rectal dose sparing in conformal radiation therapy of prostate cancer. A prospective three-dimensional analysis.
abstract: OBJECTIVE
  The use of a rectal balloon leads to a protection of the posterior rectal wall in irradiation of prostate cancer. The purpose of this analysis was to quantitatively assess the optimal volume in rectal balloons concerning rectal dose sparing in different clinical target volumes (CTVs) in prostate cancer irradiation.
  
  
  METHODS
  14 patients with localized prostate cancer undergoing external beam radiotherapy were investigated. The prostate, the entire and the proximal seminal vesicles were delineated as CTV. Treatment plans without a rectal balloon and with a rectal balloon inflated with 40 ml (six patients) or 60 ml air (eight patients) were generated for each CTV and compared concerning rectal dose volume histograms.
  
  
  RESULTS
  The use of a rectal balloon filled with 40 ml air led to no significant advantage in radiation exposure of the rectal wall in all CTVs. The use of a rectal balloon filled with 60 ml air resulted in a significant decrease of the exposed rectal wall volume in all CTVs with a reduced estimated risk for chronic toxicity in case of inclusion of the proximal or entire seminal vesicles into the CTV.
  
  
  CONCLUSIONS
  The use of a rectal balloon filled with 60 ml air led to a significantly decreased proportion of the irradiated rectal wall for all CTVs. This volume filled in rectal balloons is therefore recommended for use. In case of irradiation of the prostate without the seminal vesicles, the use of a rectal balloon should be considered carefully concerning the patients' imaginable discomfort using a rectal balloon and a questionable advantage concerning the estimated risk for chronic toxicity.
authors.affiliation: Klinik für Strahlentherapie und Radioonkologie, Robert-Koch-Strasse 40, 37075 Göttingen, Germany. ahille@med.uni-goettingen.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Hille
authors.forename: Heinz
authors.initials: H
authors.lastname: Schmidberger
authors.forename: Nadja
authors.initials: N
authors.lastname: Töws
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Weiss
authors.forename: Hilke
authors.initials: H
authors.lastname: Vorwerk
authors.forename: Clemens F
authors.initials: CF
authors.lastname: Hess
mesh_terms: D002404:Catheterization; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D012007:Rectum / Q000528:radiation effects*; D012669:Seminal Vesicles / Q000528:radiation effects; D014057:Tomography, X-Ray Computed