ABDOMINAL WALL COMPRESSION AND PRONE POSITION EFFECTIVELY DISPLACE PELVIC SMALL BOWEL AND REDUCE IRRADIATED VOLUME
Abstract
Objectives: Small bowel is a dose limiting structure for pelvic irradiation, which is commonly used in several cancers. Moving the small bowel out of the pelvic irradiated field results in decreasing complications. In this study, we evaluate the efficacy of abdominal wall compression and prone position in displacing the small bowel out of the pelvic irradiated field, reducing patient thickness, decreasing the irradiated volume and increasing dose uniformity.
Material and Method: Ten cervical cancer patients with at least 20 cms separation at center of pelvic field were entered into this study. Oral contrast medium was used to visualize pelvic small bowel. Volume of irradiated tissue and small bowel area within the treatment ports was measured in supine position before and after abdominal wall compression and in prone position. The study was performed twice in each patient.
Results: The distance between the Anterior and Posterior field at center of pelvic field was decrease by about 3.8 cms after abdominal wall compression and 1.6 cms in prone position. Average of reduced irradiated volume after compression and prone position was 13.14% and 5.51% respectively (p<0.005). Better dose uniformity was obtained. Additionally, 49.49% of the mean small bowel area was diminished by abdominal wall compression whereas 26.40% by prone position (p<0.005).
Conclusion: Abdominal wall compression and prone position were effectively able to displace small bowel and reduce irradiated volume within pelvic treatment field. These simple, safe, inexpensive and reproducible techniques may decrease complications from pelvic irradiation.
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