title: Effect of rectal enemas on rectal dosimetric parameters during high-dose-rate vaginal cuff brachytherapy: A prospective trial.
abstract: OBJECTIVE
  To evaluate the effects of rectal enemas on rectal doses during postoperative high-dose-rate (HDR) vaginal cuff brachytherapy (VCB).
  
  
  METHODS
  This prospective trial included 59 patients. Two rectal cleansing enemas were self-administered before the second fraction, and fraction 1 was considered the basal status. Dose-volume histogram (DVH) values were generated for the rectum and correlated with rectal volume variation. Statistical analyses used paired and unpaired t-tests.
  
  
  RESULTS
  Despite a significant 15 % reduction in mean rectal volume (44.07 vs. 52.15 cc, p = 0.0018), 35.6 % of patients had larger rectums after rectal enemas. No significant rectal enema-related DVH differences were observed compared to the basal data. Although not statistically significant, rectal cleansing-associated increases in mean rectal DVH values were observed: D0.1 cc: 6.6 vs. 7.21 Gy; D1 cc: 5.35 vs. 5.52 Gy; D2 cc: 4.67 vs. 4.72 Gy, before and after rectal cleaning, respectively (where Dx cc is the dose to the most exposed x cm(3)). No differences were observed in DVH parameters according to rectal volume increase or decrease after the enema. Patients whose rectal volume increased also had significantly larger DVH parameters, except for D5 %, D25 %, and D50 %. In contrast, in patients whose rectal volume decreased, significance was only seen for D25 % and D50 % (Dx % dose covering x % of the volume). In the latter patients, nonsignificant reductions in D2 cc, D5 cc and V5 Gy (volume receiving at least 5 Gy) were observed.
  
  
  CONCLUSIONS
  The current rectal enemas protocol was ineffective in significantly modifying rectal DVH parameters for HDR-VCB.
authors.affiliation: Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006, Albacete, Spain. ssabaterm@gmail.com.
authors.forename: Sebastià
authors.initials: S
authors.lastname: Sabater
authors.affiliation: Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006, Albacete, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Andrés
authors.affiliation: Department of Radiation Oncology, Hospital Universitari Sant Joan, Reus, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Gascon
authors.affiliation: Gynecological Cancer Unit, Radiation Oncology Department, ICMHO, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain.
authors.forename: Angeles
authors.initials: A
authors.lastname: Rovirosa
authors.affiliation: Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006, Albacete, Spain.
authors.forename: Marimar
authors.initials: M
authors.lastname: Sevillano
authors.affiliation: Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006, Albacete, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Berenguer
authors.affiliation: Gynecological Cancer Unit, Radiation Oncology Department, ICMHO, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Camacho-Lopez
authors.affiliation: Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006, Albacete, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Aguayo
authors.affiliation: Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006, Albacete, Spain.
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Villas
authors.affiliation: Department of Radiation Oncology, Hospital Universitari Sant Joan, Reus, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Arenas
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D019583:Dose Fractionation, Radiation; D016889:Endometrial Neoplasms / Q000473:pathology / Q000628:therapy*; D004733:Enema; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008875:Middle Aged; D009367:Neoplasm Staging; D009929:Organ Size; D011446:Prospective Studies; D011874:Radiometry / Q000379:methods*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D011882:Radiotherapy, High-Energy; D012007:Rectum / Q000528:radiation effects*; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D007496:Iridium Radioisotopes
keywords: Dose–volume histogram; Endometrial carcinoma; Radiotherapy; Recommendations; Toxicity