Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-11T03:22:34.820Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of a Belly Board immobilisation device for rectal cancer patients receiving pre-operative chemoradiation

Published online by Cambridge University Press:  11 August 2014

Andrew Gaya ,
Patryk Brulinski ,
Stephen L. Morris ,
Kim A. Ball ,
Anthony G. Greener ,
Sue Corcoran ,
Anthony Henrys ,
David B. Landau ,
George Mikhaeel  and
Martin D. Leslie
...Show all authors
Andrew Gaya*
Affiliation:
Department of Clinical Oncology
Patryk Brulinski
Affiliation:
Department of Clinical Oncology
Stephen L. Morris
Affiliation:
Department of Clinical Oncology
Kim A. Ball
Affiliation:
Department of Radiotherapy
Anthony G. Greener
Affiliation:
Department of Medical Physics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Sue Corcoran
Affiliation:
Department of Medical Physics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Anthony Henrys
Affiliation:
Department of Radiotherapy
David B. Landau
Affiliation:
Department of Clinical Oncology
George Mikhaeel
Affiliation:
Department of Clinical Oncology
Martin D. Leslie
Affiliation:
Department of Clinical Oncology
Anna Z. Winship
Affiliation:
Department of Clinical Oncology
*
Correspondence to: Dr Andrew Gaya, Department of Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK. Tel: +44 (0) 20 7188 1459. Fax: +44 (0) 20 7009 4272. E-mail: andrew.gaya@gstt.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose

To evaluate the efficacy of a Belly Board immobilisation device for rectal cancer patients.

Materials and methods

A randomised trial in patients receiving neo-adjuvant chemoradiation for rectal carcinoma was established. Patients were treated, prone with control arm, according to standard departmental protocol and experimental arm with the use of a Belly Board. All treatments were planned using a three-field technique. The primary endpoints were reproducibility and irradiated small bowel volume. Questionnaires were used to assess secondary endpoints of patient comfort, ease of set-up and acute toxicities.

Results

Pre-planned interim analysis was performed after recruiting 30 patients. In all, 348 portal images were analysed retrospectively. Around 8 out of 12 parameters measuring set-up reproducibility were in favour of the Belly Board arm. Random error in the anterior–posterior direction was improved and statistically significant in the experimental arm (95% CI; p≤0·05). Small bowel V15 was significantly lower in the Belly Board position (mean V15=14·5%) compared with the standard position (mean V15=21·4%), paired t-test 95% CI; p=0·035. Also, patients’ comfort satisfaction was greater in the Belly Board arm.

Conclusions

Set-up reproducibility, small bowel V15, patient comfort and satisfaction were all significantly improved by the use of the Belly Board.

Keywords

Belly Board immobilisationradiotherapyrectal cancerset-up reproducibilitysmall bowel toxicity
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Supplement 4 , December 2014 , pp. 403 - 409
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Krook, J E, Moertel, C G, Gunderson, L L et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991; 324: 709–715.Google Scholar
2. MacFarlane, J K, Ryall, R D H, Heald, R J. Mesorectal excision for rectal cancer. Lancet 1993; 341: 457–460.Google Scholar
3. Gallagher, M J, Brereton, H D, Rostock, R A et al. A prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic radiation. Int J Radiat Oncol Biol Phys 1986; 12: 1565–1573.CrossRefGoogle Scholar
4. Baglan, K L, Frazier, R C, Yan, D, Huang, R R, Martinez, A A, Robertson, J M. The dose-volume relationship of acute small bowel toxicity from concurrent 5-FU-based chemotherapy and radiation therapy for rectal cancer. Int J Radiat Oncol Biol Phys 2002; 52: 176–183.Google Scholar
5. Emami, B, Lyman, J, Brown, A et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991; 21: 109–122.CrossRefGoogle ScholarPubMed
6. Cole, H. Displacement of small bowel from pelvic radiation field. Lancet 1988; 2: 1341–1342.Google Scholar
7. Gunderson, L L, Russell, A H, Llewellyn, H J, Doppke, K P, Tepper, J E. Treatment planning for colorectal cancer: radiation and surgical techniques and value of small-bowel films. Int J Radiat Oncol Biol Phys 1985; 11: 1379–1393.Google Scholar
8. Das, I J, Lanciano, R M, Movsas, B, Kagawa, K, Barnes, S J. Efficacy of a belly board device with CT-simulation in reducing small bowel volume within pelvic irradiation fields. Int J Radiat Oncol Biol Phys 1997; 39: 67–76.CrossRefGoogle ScholarPubMed
9. Shanahan, T G, Mehta, M P, Bertelrud, K L et al. Minimization of small bowel volume within treatment fields utilizing customized ‘belly boards’. Int J Radiat Oncol Biol Phys 1990; 19: 469–476.Google Scholar
10. Huh, S J, Lim, D H, Ahn, Y C et al. Effect of customized small bowel displacement system in pelvic irradiation. Int J Radiat Oncol Biol Phys 1998; 40: 623–627.CrossRefGoogle ScholarPubMed
11. Rudat, V, Flentje, M, Engenhart, R, Metzger, M, Wannenmacher, M. The belly-board technic for the sparing of the small intestine. Studies on positioning accuracy taking into consideration conformational irradiation technics. Strahlenther Onkol 1995; 171: 437–443.Google Scholar
12. Olofsen-van Acht, M J, Quint, S, Seven, M et al. Three-dimensional treatment planning for postoperative radiotherapy in patients with node-positive cervical cancer. Comparison between a conventional and a conformal technique. Strahlenther Onkol 1999; 175: 462–469.Google Scholar
13. Portelance, L, Chao, K S, Grigsby, P W, Bennet, H, Low, D. Intensity-modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. Int J Radiat Oncol Biol Phys 2001; 51: 261–266.Google Scholar
14. Nijkamp, J, Doodeman, B, Marijnen, C, Vincent, A, van Vliet-Vroegindeweij, C. Bowel exposure in rectal cancer IMRT using prone, supine, or a belly board. Radiother Oncol 2012; 102: 22–29.Google Scholar
15. Wiesendanger-Wittmer, E M, Sijtsema, N M, Muijs, C T, Beukema, J C. Systematic review of the role of a belly board device in radiotherapy delivery in patients with pelvic malignancies. Radiother Oncol 2012; 102 (3): 325–334.CrossRefGoogle ScholarPubMed
16. Bidmead, M, Coffey, M, Crellin, A et al. Geometric Uncertainties in Radiotherapy: Defining the Target Volume. London, UK: British Institute of Radiology, 2003.Google Scholar
17. Morgan, S, Greener, A G. ImageTrack: A Software Tool for Analyzing and Refining Treatment Verification. Programme Abstract from ‘IMRT—A Clinical Service for the 21st Century’ Meeting. Manchester, UK: Institute of Physics in Engineering and Medicine, 2005.Google Scholar
18. Greener, A G. Practical Determination of Systematic and Random Set-Up Errors Using Portal Imaging. Geometric Uncertainties in Radiotherapy: Appendix 2c. London, UK: British Institute of Radiology, 2003.Google Scholar
19. Trotti, A, Colevas, A D, Setser, A et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 2003; 13: 176–181.Google Scholar
20. Altman, D G. Statistics and ethics in medical research: III. How large a sample? Br Med J 1980; 281: 1336–1338.Google Scholar
21. Lee, S H, Kim, T H, Kim, D Y et al. The effect of belly board location in rectal cancer patients treated with preoperative radiotherapy. Clin Oncol (R Coll Radiol) 2006; 18: 441–446.Google Scholar
22. Kim, T H, Chie, E K, Kim, D Y et al. Comparison of the belly board device method and the distended bladder method for reducing irradiated small bowel volumes in preoperative radiotherapy of rectal cancer patients. Int J Radiat Oncol Biol Phys 2005; 62: 769–775.Google Scholar
23. Ghosh, K, Padilla, L A, Murray, K P, Downs, L S, Carson, L F, Dusenbery, K E. Using a belly board device to reduce the small bowel volume within pelvic radiation fields in women with postoperatively treated cervical carcinoma. Gynecol Oncol 2001; 83: 271–275.CrossRefGoogle ScholarPubMed
24. Martin, J, Fitzpatrick, K, Horan, G et al. Treatment with a belly-board device significantly reduces the volume of small bowel irradiated and results in low acute toxicity in adjuvant radiotherapy for gynecologic cancer: results of a prospective study. Radiother Oncol 2005; 74: 267–274.Google Scholar
Supplementary material: File

Gaya Supplementary Material

Supplementary Material

Download Gaya Supplementary Material(File)
File 117.8 KB
Supplementary material: PDF

Gaya Supplementary Material

Supplementary Material

Download Gaya Supplementary Material(PDF)
PDF 150.9 KB