向正确方向倾斜：降低盆腔放疗患者小肠剂量的trendelenburg体位的前瞻性可行性研究

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-01 DOI:10.1016/S0167-8140(25)04669-9

Daniel Tesolin , Rabbiya Aslam , Kristopher Dennis , Shawn Malone , Sondos Zayed , Gordon Locke , Alain Haddad , Jamie Bahm , Steve Andruysk , Madeleine Van De Kleut , Sarah Spooner , Tim Ramsay , Katie Lekx-Toniolo , Claire Footit , Geoff Reid , Ron Romain , Nikitha Moideen

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引用次数: 0

摘要

目的：在泌尿生殖系统、胃肠道和妇科恶性肿瘤中，盆腔放疗（RT）经常是治疗的一个组成部分。这通常会导致小肠照射引起的急性和慢性胃肠道症状。我们研究了一种新的模拟技术，使用Trendelenburg位来减少小肠剂量。本研究比较了计划接受容积调节弧线治疗（VMAT）的盆腔放疗患者的仰卧位、俯卧位和Trendelenburg位的舒适度和剂量学差异。材料和方法：在这项REB批准的前瞻性试验中，招募了20名患者。患者接受盆腔放疗选择性淋巴结放疗。那些行动能力严重受限的人被排除在外。采用仰卧位、俯卧位和Trendelenburg位进行CT模拟。Trendelenburg的位置是使用20度角的泡沫楔来实现的。扫描后，患者回答了一份李克特舒适度问卷。绘制每组扫描的治疗体积、小肠、大肠和肠袋结构轮廓，然后制定VMAT计划。结果：20例患者入组，中位年龄为73(45-90)，中位BMI为26（19.3-33.5）。原发部位为前列腺（40%,n=8）、直肠（45%,n=9）和子宫内膜（15%,n=3）。大多数患者认为仰卧位至少有点舒服（95%,n=19），超过一半的患者认为俯卧位（55%,n=11）和Trendelenburg位（65%,n=13）至少有点舒服。大多数患者认为他们可以完成所有体位（仰卧位100%，俯卧位90%，Trendelenburg位95%）的整个RT过程。一名患者不能忍受俯卧位，另一名患者不能忍受Trendelenburg位。在发现仰卧或俯卧不舒服的患者中，80%的人认为Trendelenburg睡姿很舒服。平均而言，与俯卧位或Trendelenburg位相比，几个小肠剂量参数分别减少（小肠Dmean: 1802.9 cGy, 1484.3 cGy, 1424.9 cGy, p=0.0026），（小肠D0.03: 4933.6 cGy, 4455.1 cGy, 4465.2 cGy, p=0.0085），（小肠V15: 315.6 cc, 175.3 cc, 185.2 cc, p=0.0001），（肠袋V45: 76.6 cc, 76.2 cc, 65.1 cc, p=0.2042）。结论：总的来说，这项研究表明Trendelenburg是一种比俯卧更舒适的治疗体位，而剂量学分析显示，与仰卧位相比，小肠剂量更低。未来的研究需要评估在Trendelenburg位治疗的患者的可重复性和临床益处。

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LEANING IN THE RIGHT DIRECTION: A PROSPECTIVE FEASIBILITY TRIAL OF THE TRENDELENBURG POSITION FOR REDUCING SMALL BOWEL DOSE IN PELVIC RADIOTHERAPY PATIENTS

Purpose:

In genitourinary, gastrointestinal and gynecologic malignancies, pelvic radiotherapy (RT) is frequently a component of treatment. This often results in acute and chronic gastrointestinal symptoms from small bowel irradiation. We investigated a novel simulation technique using Trendelenburg position to decrease small bowel dose. This study compares comfort and dosimetric differences of supine, prone and the Trendelenburg position in patients planned for pelvic RT with volumetric modulated arc therapy (VMAT).

Materials and Methods:

In this REB approved prospective trial, 20 patients were recruited. Patients that undergoing pelvic RT with elective nodal radiation were included. Those with severe limitation in mobility were excluded. CT simulation was completed in the supine, prone and Trendelenburg positions. The Trendelenburg position was achieved using a foam wedge at a 20-degree angle. Patients answered a Likert scale questionnaire on comfort after the scans. The treatment volumes, small bowel, large bowel and bowel bag structures were contoured for each scan set and VMAT plans were then developed.

Results:

Twenty patients were recruited with a median age of 73 (45-90) and median BMI of 26 (19.3-33.5). Primary sites were prostate (40%, n=8), rectal (45%, n=9) and endometrial (15%, n=3). Most patients found the supine position at least somewhat comfortable (95%, n=19) and over half felt the prone (55% n=11) and Trendelenburg positions (65%, n=13) to be at least somewhat comfortable. Most patients felt they could complete an entire course of RT in all positions (supine 100%, prone 90%, Trendelenburg 95%). One patient could not tolerate prone and another patient could not tolerate Trendelenburg position. Of the patients that found supine or prone uncomfortable, 80% found Trendelenburg position comfortable. On average, there was reduction in several small bowel dose parameters when comparing supine to prone or Trendelenburg position respectively (small bowel Dmean: 1802.9 cGy, 1484.3 cGy, 1424.9 cGy, p=0.0026), (small bowel D0.03: 4933.6 cGy, 4455.1 cGy, 4465.2 cGy, p=0.0085), (small bowel V15: 315.6 cc, 175.3 cc, 185.2 cc, p=0.0001), (bowel bag V45: 76.6 cc, 76.2 cc, 65.1 cc, p=0.2042).

Conclusions:

Overall, this study suggests the Trendelenburg is a more comfortable treatment position than prone while demonstrating lower small bowel doses compared to supine position on dosimetric analysis. Future studies are required to assess reproducibility and clinical benefit to patients treated in the Trendelenburg position.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.