The Effect of Contrast Material in Three Dimensional Conformal and Helical Treatment Plans in Rectal Radiotherapy

Year 2024, Volume: 20 Issue: 3, 58 - 64, 30.09.2024

Hikmettin Demir , Gül Kanyılmaz , Osman Vefa Gül

https://doi.org/10.18466/cbayarfbe.1493473

Abstract

The aim of this study to investigate the impact of contrast agent used for imaging purposes in the treatment of neoadjuvant rectal cancer patients. In rectal radiotherapy, contrast agent is used during the treatment simulation but the patient treated without contrast. In our study, we will examine whether CTs taken with contrast agent are sufficient for clinical application. A total of eighteen patients who had undergone neoadjuvant treatment with rectal cancer randomly selected. Two different CT scans were performed for each patient. The contours were delineated on a non-contrast CT images with the help of image fusion with contrast CT images. Then, the contours drawn on the non-contrast CT were copied to the contrast-enhanced CT with the help of fusion to be used in contrast CT plans for our retrospective study. Subsequently, all plans were generated in Eclipse TPS and Accuray Precision TPS. Finally the plans with contrast agent and non-constrat agent were compared. 3DCRT plans were compared for contrast and non-contrast images, no significant differences were observed in either the PTV or the maximum and mean values of critical organs. It was observed that the average post-contrast doses increased significantly for small bowel only in helical therapy (p = 0.019). As a result, no significant difference was observed in terms of PTV and critical organs in the comparison of 3DCRT plans. In the comparison of helical plans, there was only a significant difference in the bladder. Based on these results, we suggest that planning can be done with a single contrast CT for 3DCRT treatments, both to avoid further discomfort for the patient and to prevent additional tomography doses. On the other hand, for helical therapy, we believe that it can be clinically evaluated whether the treatment will be performed with contrast CT depending on the patient's condition.

Keywords

Contrast, conformal radiotherapy, helical therapy, rectum

References

• [1]. H. Sung, J. Ferlay, R.L. Siegel, M. Laversanne, I. Soerjomataram, A. Jemal, F. Bray, Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries, CA: a cancer journal for clinicians 71(3) (2021) 209-249.
• [2]. Z. Yu, Y. Hao, Y. Huang, L. Ling, X. Hu, S. Qiao, Radiotherapy in the preoperative neoadjuvant treatment of locally advanced rectal cancer, Frontiers in Oncology 13 (2023).
• [3]. R. Glynne-Jones, L. Wyrwicz, E. Tiret, G. Brown, C.d. Rödel, A. Cervantes, D. Arnold, Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, Annals of Oncology 28 (2017) iv22-iv40.
• [4]. A.B. Benson, A.P. Venook, M.M. Al-Hawary, L. Cederquist, Y.-J. Chen, K.K. Ciombor, S. Cohen, H.S. Cooper, D. Deming, P.F. Engstrom, Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology, Journal of the National Comprehensive Cancer Network 16(7) (2018) 874-901.
• [5]. M.J. van der Valk, C.A. Marijnen, B. van Etten, E.A. Dijkstra, D.E. Hilling, E.M.-K. Kranenbarg, H. Putter, A.G. Roodvoets, R.R. Bahadoer, T. Fokstuen, Compliance and tolerability of short-course radiotherapy followed by preoperative chemotherapy and surgery for high-risk rectal cancer–Results of the international randomized RAPIDO-trial, Radiotherapy and Oncology 147 (2020) 75-83.
• [6]. T. Conroy, N. Lamfichekh, P.-L. Etienne, E. Rio, E. Francois, N. Mesgouez-Nebout, V. Vendrely, X. Artignan, O. Bouché, D. Gargot, Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiation in patients with locally advanced rectal cancer: final results of PRODIGE 23 phase III trial, a UNICANCER GI trial, American Society of Clinical Oncology, 2020.
• [7]. K.C. Peeters, C.A. Marijnen, I.D. Nagtegaal, E.K. Kranenbarg, H. Putter, T. Wiggers, H. Rutten, L. Pahlman, B. Glimelius, J.W. Leer, The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma, Annals of surgery 246(5) (2007) 693-701.
• [8]. M. Zoccali, A. Fichera, Role of radiation in intermediate-risk rectal cancer, Annals of surgical oncology 19 (2012) 126-130.
• [9]. J.-P. Gérard, T. Conroy, F. Bonnetain, O. Bouché, O. Chapet, M.-T. Closon-Dejardin, M. Untereiner, B. Leduc, É. Francois, J. Maurel, Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203, Journal of clinical oncology 24(28) (2006) 4620-4625.
• [10]. A. Sipaviciute, E. Sileika, A. Burneckis, A. Dulskas, Late gastrointestinal toxicity after radiotherapy for rectal cancer: a systematic review, International Journal of Colorectal Disease 35 (2020) 977-983.
• [11]. A. Dulskas, P. Kavaliauskas, L. Pilipavicius, M. Jodinskas, M. Mikalonis, N.E. Samalavicius, Long-term bowel dysfunction following low anterior resection, Scientific reports 10(1) (2020) 11882.
• [12]. N.P. McKenna, K.A. Bews, K.J. Yost, R.R. Cima, E.B. Habermann, Bowel dysfunction after low anterior resection for colorectal cancer: a frequent late effect of surgery infrequently treated, Journal of the American College of Surgeons 234(4) (2022) 529-537.
• [13]. E. Pape, P. Pattyn, A. Van Hecke, N. Somers, D. Van De Putte, W. Ceelen, E. van Daele, W. Willaert, Y. Van Nieuwenhove, Rectal cancer survivorship: the struggle of the low anterior resection syndrome (LARS), Annals of Oncology 29 (2018) viii698.
• [14]. B. Celerier, Q. Denost, B. Van Geluwe, A. Pontallier, E. Rullier, The risk of definitive stoma formation at 10 years after low and ultralow anterior resection for rectal cancer, Colorectal disease 18(1) (2016) 59-66.
• [15]. M. Bhushan, D. Tripathi, G. Yadav, L. Kumar, A. Dewan, S. Tandon, G. Kumar, I.K. Wahi, M. Gairola, Effect of contrast medium on treatment modalities planned with different photon beam energies: a planning study, reports of practical Oncology and radiotherapy 26(5) (2021) 688-711.
• [16]. J. Nasrollah, M. Mikaeil, E. Omid, S.S. Mojtaba, Z. Ahad, Influence of the intravenous contrast media on treatment planning dose calculations of lower esophageal and rectal cancers, Journal of cancer research and therapeutics 10(1) (2014) 147-152.
• [17]. S. Heydarheydari, N. Farshchian, A. Haghparast, Influence of the contrast agents on treatment planning dose calculations of prostate and rectal cancers, Reports of Practical Oncology & Radiotherapy 21(5) (2016) 441-446.
• [18]. N. Montero-Oleas, A. Imbaquingo-Cabrera, A. Coloma-Espin, V. Collantes-Cruz, C. Molineros, C. Núñez-Silva, Dosimetric effects of oral contrast in the planning of conventional radiotherapy and IMRT, for rectal cancer treatment, Journal of Radiotherapy in Practice 22 (2023) e54.
• [19]. Y. Shibamoto, A. Naruse, H. Fukuma, S. Ayakawa, C. Sugie, N. Tomita, Influence of contrast materials on dose calculation in radiotherapy planning using computed tomography for tumors at various anatomical regions: a prospective study, Radiotherapy and oncology 84(1) (2007) 52-55.