Clinical and translational radiation oncology · 2026
Is rectal preparation necessary in contemporary image-guided prostate radiotherapy?
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Alexander S E, Booth L, Delacroix L, Garrad E, Gordon A, Guerra A, Mohammad H, Nill S, Ockwell C, Oelfke U, McNair H A, Tree A C
Аннотация
INTRODUCTION: Rectal preparation during prostate radiotherapy (RT) was established in the era of two-dimensional bone-based IGRT, but its necessity with contemporary three-dimensional IGRT is uncertain. We examined the impact of omitting rectal preparation on prostate inter- and intrafraction motion, rectal volume, and their relationship.
METHODS: Two datasets were analysed. Dataset one included patients receiving RT for de novo prostate cancer on a C-arm linear accelerator, stratified by use of micro-enema or no rectal preparation. Interfraction prostate motion was calculated from daily CBCT, and compared between preparation groups, with further stratification by rectal volume on planning CT (pCT) < 90 or ≥ 90 cm3. Correlation between rectal volume and prostate motion was assessed.Dataset two comprised 40 patients with localised prostate cancer treated without rectal preparation. Inter- and intrafraction prostate motion were calculated, with intrafraction motion assessed using post-treatment CBCT acquired at five RT fractions. The rectum was contoured on pre-treatment CBCT, and correlation between rectal volume and intrafraction motion evaluated.
RESULTS: Dataset one included 255 patients: 96 with and 159 without rectal preparation. Median rectal volume on pCT (proportion with rectal volume ≥ 90 cm3) was 64 cm3 (18 %) in the preparation group and 68 cm3 (28 %) in the no-preparation group. Interfraction motion differences were small; however, patients without preparation and a pCT rectal volume ≥ 90 cm3 demonstrated increased posterior motion.In dataset two, median rectal volume on pCT was 75 cm3, 33 % had a rectal volume ≥ 90 cm3. Intrafraction motion was modest and not influenced by pCT rectal volume. No correlation was observed between rectal volume during treatment and intrafraction motion.
CONCLUSION: Rectal preparation reduced the proportion of patients with a large rectum on pCT by only 10-15 %. A large rectum modestly increased interfraction motion but did not affect intrafraction motion. Findings suggest rectal preparation is not universally required with contemporary IGRT.
METHODS: Two datasets were analysed. Dataset one included patients receiving RT for de novo prostate cancer on a C-arm linear accelerator, stratified by use of micro-enema or no rectal preparation. Interfraction prostate motion was calculated from daily CBCT, and compared between preparation groups, with further stratification by rectal volume on planning CT (pCT) < 90 or ≥ 90 cm3. Correlation between rectal volume and prostate motion was assessed.Dataset two comprised 40 patients with localised prostate cancer treated without rectal preparation. Inter- and intrafraction prostate motion were calculated, with intrafraction motion assessed using post-treatment CBCT acquired at five RT fractions. The rectum was contoured on pre-treatment CBCT, and correlation between rectal volume and intrafraction motion evaluated.
RESULTS: Dataset one included 255 patients: 96 with and 159 without rectal preparation. Median rectal volume on pCT (proportion with rectal volume ≥ 90 cm3) was 64 cm3 (18 %) in the preparation group and 68 cm3 (28 %) in the no-preparation group. Interfraction motion differences were small; however, patients without preparation and a pCT rectal volume ≥ 90 cm3 demonstrated increased posterior motion.In dataset two, median rectal volume on pCT was 75 cm3, 33 % had a rectal volume ≥ 90 cm3. Intrafraction motion was modest and not influenced by pCT rectal volume. No correlation was observed between rectal volume during treatment and intrafraction motion.
CONCLUSION: Rectal preparation reduced the proportion of patients with a large rectum on pCT by only 10-15 %. A large rectum modestly increased interfraction motion but did not affect intrafraction motion. Findings suggest rectal preparation is not universally required with contemporary IGRT.