Dosimetric Impact of Bladder Volumetric Changes During Helical Radiotherapy for Rectal Cancer

Document Type : Original Paper


1 University of Sağlık Bilimleri, Erzurum Regional Training and Research Hospital, Department of Radiation Oncology Department of Radiation Oncology, Akdeniz University Faculty of Medicine

2 University of Sağlık Bilimleri, Erzurum Regional Training and Research Hospital, Department of Radiation Oncology Department of Radiation Oncology, Marmara University Faculty of Medicine


Introduction: This study aims to investigate the dosimetric impact of bladder volumetric changes during helical radiotherapy (RT) for rectal cancer (RC).
Material and Methods: A total of 42 RC patients' helical RT treatment plans were analyzed. The bladder volumes were divided into 3 groups (Group1: V<100ml, Group2 100ml≤V≤200ml, and Group3V>200ml). Planning target volume (PTV), PTV boost, bladder, bowel, right, and left femoral head dose values were analyzed and compared between groups. Statistical analysis was done with a one-way ANOVA test in SPSS18.0 program. A value of p <0.05 was considered statistically significant.
Results: The median age of the patients was 59 (range:22-87) and bladder volume ranged from 41.44ml-620.82ml. In the dosimetric data comparison of the patient groups with different bladder volumes, the D50 dose values of PTV and PTV boost volume was highest in Group 3 (p=0.039). No statistical significance was found between PTV and PTV boost’ doses of D98 and D2 ​​and groups. The optimum PTV dose value was in Group2. Bowel doses were highest in Group 1. As the bladder volume increased, the Dmax, Dmean, V15%, and V30% values of the bowel doses decreased. There was a statistically significant relationship between bladder Dmax doses and groups (p = 0.024). Femoral heads doses increased in proportion to increasing bladder volume groups and these results were statistically significant for V5% and V30% (p <0.05).
Conclusion: In our study, as the bladder volume increased, there was an inversely proportional decrease in the bowel doses and a directly proportional increase in the femoral head and bladder doses. Bladder volume values significantly affected values of the target and critical organs dose during helical RT for RC


Main Subjects

  1. Owens R, Mukherjee S, Padmanaban S, Hawes E, Jacobs C, Weaver A, Betts M, Muirhead R. Intensity-modulated radiotherapy with a simultaneous integrated boost in rectal cancer. Clinical Oncology. 2020 Jan 1;32(1):35-42.
  2. Lupattelli M, Matrone F, Gambacorta MA, Osti M, Macchia G, Palazzari E, Nicosia L, Navarria F, Chiloiro G, Valentini V, Aristei C. Preoperative intensity-modulated radiotherapy with a simultaneous integrated boost combined with Capecitabine in locally advanced rectal cancer: short-term results of a multicentric study. Radiation Oncology. 2017 Dec;12(1):1-7.
  3. Jhaveri PM, Teh BS, Paulino AC, Smiedala MJ, Fahy B, Grant W, McGary J, Butler EB. Helical tomotherapy significantly reduces dose to normal tissues when compared to 3D-CRT for locally advanced rectal cancer. Technology in cancer research & treatment. 2009 Oct;8(5):379-85.
  4. Czito BG, Meyer J. Radiation therapy in anal and rectal cancer. Surgical Oncology Clinics. 2013 Jul 1;22(3):525-43.
  5. Bae BK, Kang MK, Kim JC, Kim MY, Choi GS, Kim JG, Kang BW, Kim HJ, Park SY. Simultaneous integrated boost intensity-modulated radiotherapy versus 3-dimensional conformal radiotherapy in preoperative concurrent chemoradiotherapy for locally advanced rectal cancer. Radiation oncology journal. 2017 Sep;35(3):208.
  6. Nomiya T, Akamatsu H, Harada M, Ota I, Hagiwara Y, Ichikawa M, Miwa M, Kawashiro S, Hagiwara M, Chin M, Hashizume E. Modified simultaneous integrated boost radiotherapy for an unresectable huge refractory pelvic tumor diagnosed as a rectal adenocarcinoma. World Journal of Gastroenterology: WJG. 2014 Dec 28;20(48):18480.
  7. Hong TS, Moughan J, Garofalo M, Bendell J, Berger AC, Oldenburg NB, Anne PA, Perera F, Lee RJ, Jabbour SK, Nowlan A. Efficacy outcomes from RTOG 0822: a phase II study of neoadjuvant IMRT with capecitabine (c) and oxaliplatin (o) in patients with locally advanced rectal cancer. International Journal of Radiation Oncology, Biology, Physics. 2014 Sep 1;90(1):S21.
  8. Dapper H, Rodríguez I, Münch S, Peeken JC, Borm K, Combs SE, Habermehl D. Impact of VMAT-IMRT compared to 3D conformal radiotherapy on anal sphincter dose distribution in neoadjuvant chemoradiation of rectal cancer. Radiation Oncology. 2018 Dec;13(1):1-9.
  9. Tey J, Leong CN, Cheong WK, Sze TG, Yong WP, Tham IW, Lee KM. A phase II trial of preoperative concurrent chemotherapy and dose escalated intensity modulated radiotherapy (IMRT) for locally advanced rectal cancer. Journal of Cancer. 2017;8(16):3114.
  10. But-Hadzic J, Anderluh F, Brecelj E, Edhemovic I, Secerov-Ermenc A, Hudej R, Jeromen A, Kozelj M, Krebs B, Oblak I, Omejc M. Acute toxicity and tumor response in locally advanced rectal cancer after preoperative chemoradiation therapy with shortening of the overall treatment time using intensity-modulated radiation therapy with simultaneous integrated boost: a phase 2 trial. International Journal of Radiation Oncology* Biology* Physics. 2016 Dec 1;96(5):1003-10.
  11. Nagata H, Sugimoto S, Hongo H, Hashimoto H, Sato Y, Kawabata T, Watanabe H, Inoue T, Usui K, Kurokawa C, Sasai K. Patient organ doses from megavoltage computed tomography delivery with a helical tomotherapy unit using a general treatment planning system. Journal of Radiation Research. 2019 May 1;60(3):401-11.
  12. Huang MY, Chen CF, Huang CM, Tsai HL, Yeh YS, Ma CJ, Wu CH, Lu CY, Chai CY, Huang CJ, Wang JY. Helical tomotherapy combined with capecitabine in the preoperative treatment of locally advanced rectal cancer. BioMed Research International. 2014 May 6;2014.
  13. Sithamparam S, Ahmad R, Sabarudin A, Othman Z, Ismail M. Bladder filling variation during conformal radiotherapy for rectal cancer. InJournal of Physics: Conference Series 2017 May 1 (Vol. 851, No. 1, p. 012026). IOP Publishing.
  14. Ma S, Zhang T, Jiang L, Qin W, Lu K, Zhang Y, Wang R. Impact of bladder volume on treatment planning and clinical outcomes of radiotherapy for patients with cervical cancer. Cancer Management and Research. 2019;11:7171.
  15. Ye L, Wu XR, Li KM, Bai H, Zheng J, Ai YQ. Effects of bladder status on cervical cancer treatment with intensity‐modulated radiation therapy plans. Precision Radiation Oncology. 2017 Sep;1(3):94-101.
  16. Dutta S, Dewan A, Mitra S, Sharma MK, Aggarwal S, Barik S, Suhail MM, Bhushan M, Sharma A, Wahi IK, Dobriyal K. Dosimetric impact of variable bladder filling on IMRT planning for locally advanced carcinoma cervix. Journal of the Egyptian National Cancer Institute. 2020 Dec;32(1):1-0.
  17. Nakamura N, Shikama N, Takahashi O, Sekiguchi K, Hama Y, Akahane K, Nakagawa K. The relationship between the bladder volume and optimal treatment planning in definitive radiotherapy for localized prostate cancer. Acta Oncologica. 2012 Jul 1;51(6):730-4.
  18. Urbano MT, Henrys AJ, Adams EJ, Norman AR, Bedford JL, Harrington KJ, Nutting CM, Dearnaley DP, Tait DM. Intensity-modulated radiotherapy in patients with locally advanced rectal cancer reduces volume of bowel treated to high dose levels. International Journal of Radiation Oncology* Biology* Physics. 2006 Jul 1;65(3):907-16.
  19. Marks LB, Carroll PR, Dugan TC, Anscher MS. The response of the urinary bladder, urethra, and ureter to radiation and chemotherapy. International Journal of Radiation Oncology* Biology* Physics. 1995 Mar 30;31(5):1257-80.
  20. Brierley JD, Cummings BJ, Wong CS, McLean M, Cashell A, Manter S. The variation of small bowel volume within the pelvis before and during adjuvant radiation for rectal cancer. Radiotherapy and Oncology. 1994 May 1;31(2):110-6.
  21. Kim TH, Chie EK, Kim DY, Park SY, Cho KH, Jung KH, Kim YH, Sohn DK, Jeong SY, Park JG. 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. International Journal of Radiation Oncology* Biology* Physics. 2005 Jul 1;62(3):769-75.
  22. Cramp L, Connors V, Wood M, Westhuyzen J, McKay M, Greenham S. Use of a prospective cohort study in the development of a bladder scanning protocol to assist in bladder filling consistency for prostate cancer patients receiving radiation therapy. Journal of Medical Radiation Sciences. 2016 Sep;63(3):179-85.
  23. Lin JC, Tsai JT, Chen LJ, Li MH, Liu WH. Compared planning dosimetry of TOMO, VMAT and IMRT in rectal cancer with different simulated positions. Oncotarget. 2017 Jun 27;8(26):42020.
  24. Thondykandy BA, Swamidas JV, Agarwal J, Gupta T, Laskar SG, Mahantshetty U, Iyer SS, Mukherjee IU, Shrivastava SK, Deshpande DD. Setup error analysis in helical tomotherapy based image-guided radiation therapy treatments. Journal of Medical Physics/Association of Medical Physicists of India. 2015 Oct;40(4):233.
  25. Myerson RJ, Garofalo MC, El Naqa I, Abrams RA, Apte A, Bosch WR, Das P, Gunderson LL, Hong TS, Kim JJ, Willett CG. Elective clinical target volumes for conformal therapy in anorectal cancer: a radiation therapy oncology group consensus panel contouring atlas. International Journal of Radiation Oncology* Biology* Physics. 2009 Jul 1;74(3):824-30.
  26. Peeters KC, Van De Velde CJ, Leer JW, Martijn H, Junggeburt JM, Kranenbarg EK, Steup WH, Wiggers T, Rutten HJ, Marijnen CA. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. Journal of clinical oncology. 2005 Sep 1;23(25):6199-206.
  27. Yaparpalvi R, Mehta KJ, Bernstein MB, Kabarriti R, Hong LX, Garg MK, Guha C, Kalnicki S, Tomé WA. Contouring and constraining bowel on a full-bladder computed tomography scan may not reflect treatment bowel position and dose certainty in gynecologic external beam radiation therapy. International Journal of Radiation Oncology* Biology* Physics. 2014 Nov 15;90(4):802-8.
  28. Hatanaka S, Kawada Y, Washizu K, Utsumi N, Yamano T, Nishimura K, Watanabe T, Hosaka K, Todoroki K, Nakajima G, Shimbo M. The impact of variation in bladder volume on the doses of target and organ-at-risk in intensity-modulated radiation therapy for localized prostate cancer. Journal of Cancer Therapy. 2016 Sep 22;7(10):741-51.
  29. Lebesque JV, Bruce AM, Kroes AP, Touw A, Shouman RT, van Herk M. Variation in volumes, dose-volume histograms, and estimated normal tissue complication probabilities of rectum and bladder during conformal radiotherapy of T3 prostate cancer. International journal of radiation oncology, biology, physics. 1995 Dec 1;33(5):1109-19.
  30. Lotfi M, Bagheri MH, Mosleh-Shirazi MA, Faghihi R, Baradaran-Ghahfarokhi M. Evaluation of the Changes in the Shape and Location of the Prostate and Pelvic Organs Due to Bladder Filling and Rectal Distension. Iran Red Crescent Med J. 2011;13(8):566-75.
  31. Ahmad R, Hoogeman MS, Quint S, Mens JW, de Pree I, Heijmen BJ. Inter-fraction bladder filling variations and time trends for cervical cancer patients assessed with a portable 3-dimensional ultrasound bladder scanner. Radiotherapy and oncology. 2008 Nov 1;89(2):172-9.
  32. Kim S, You SH, Eum YJ. Assessment of inter-and intra-fractional volume of bladder and body contour by mega-voltage computed tomography in helical tomotherapy for pelvic malignancy. Radiation Oncology Journal. 2018 Sep;36(3):235.