Abstract
Background and purpose
Endorectal balloons (ERBs) are being used in prostate radiotherapy for prostate immobilization
and rectal wall (Rwall) sparing. Some of their aspects, however, have been questioned,
like patient’s tolerance and their value in modern high-precision radiotherapy. This
paper gives an overview of published data concerning ERB application in prostate radiotherapy.
Materials and methods
Systematic literature review based on PubMed/MEDLINE database searches.
Results
Overall, ERBs are tolerated well, although patients with pre-existing anorectal disease
have an increased risk of developing ERB-related toxicity. Planning studies show reduced
Rwall and anal wall (Awall) doses with ERB application. Clinical data, however, are
scarce, as only one study shows reduced late rectal damage. There is no consensus
about the immobilizing properties of ERBs and it is recommended to use additional
set-up and correction protocols, especially because there are potential pitfalls.
Conclusion
ERBs seem well-tolerated and in planning studies reduce anorectal wall doses. This
may lead to reduced anorectal toxicity, although clinical studies are warranted to
confirm this hypothesis and to further investigate the immobilizing properties of
ERBs, preferably in combination with advanced techniques for position verification.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Radiotherapy and OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Dose response in prostate cancer with 8–12 years’ follow-up.Int J Radiat Oncol Biol Phys. 2002; 54: 427-435
- High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer.J Urol. 2001; 166: 876-881
- Hazards of dose escalation in prostate cancer radiotherapy.Int J Radiat Oncol Biol Phys. 2003; 57: 1260-1268
- The association of treatment-related symptoms with quality-of-life outcomes for localized prostate carcinoma patients.Cancer. 2002; 94: 862-871
- Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial.Lancet. 1999; 353: 267-272
- High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients.Int J Radiat Oncol Biol Phys. 2002; 53: 1111-1116
- Intensity-modulated radiotherapy as primary treatment for prostate cancer: acute toxicity in 114 patients.Int J Radiat Oncol Biol Phys. 2004; 60: 777-787
- Intensity-modulated radiation therapy for prostate cancer: late morbidity and results on biochemical control.Radiother Oncol. 2007; 82: 160-166
- Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer.Int J Radiat Oncol Biol Phys. 2008; 70: 1124-1129
- Organ motion and its management.Int J Radiat Oncol Biol Phys. 2001; 50: 265-278
- Detailed mapping of prostate carcinoma foci: biopsy strategy implications.Cancer. 2000; 89: 1800-1809
- The effect of an endorectal balloon and off-line correction on the interfraction systematic and random prostate position variations: a comparative study.Int J Radiat Oncol Biol Phys. 2005; 61: 278-288
- Comparison of localization performance with implanted fiducial markers and cone-beam computed tomography for on-line image-guided radiotherapy of the prostate.Int J Radiat Oncol Biol Phys. 2007; 67: 942-953
- A practical method to achieve prostate gland immobilization and target verification for daily treatment.Int J Radiat Oncol Biol Phys. 2001; 51: 1431-1436
- The influence of a rectal balloon tube as internal immobilization device on variations of volumes and dose-volume histograms during treatment course of conformal radiotherapy for prostate cancer.Int J Radiat Oncol Biol Phys. 2002; 52: 91-100
- A clinical evaluation of setup errors for a prostate immobilization system.J Appl Clin Med Phys. 2000; 1: 138-147
- Prostate immobilization using a rectal balloon.J Appl Clin Med Phys. 2002; 3: 6-11
- Intensity-modulated radiation therapy (IMRT) for prostate cancer with the use of a rectal balloon for prostate immobilization: acute toxicity and dose-volume analysis.Int J Radiat Oncol Biol Phys. 2001; 49: 705-712
- The use of rectal balloon during the delivery of intensity modulated radiotherapy (IMRT) for prostate cancer: more than just a prostate gland immobilization device?.Cancer J. 2002; 8: 476-483
- Clinical experience with intensity-modulated radiation therapy (IMRT) for prostate cancer with the use of rectal balloon for prostate immobilization.Med Dosim. 2002; 27: 105-113
- On-line correction of beam portals in the treatment of prostate cancer using an endorectal balloon device.Radiother Oncol. 2002; 65: 39-45
- Rectal dose sparing with a balloon catheter and ultrasound localization in conformal radiation therapy for prostate cancer.Radiother Oncol. 2003; 67: 285-294
- Impact on rectal dose from the use of a prostate immobilization and rectal localization device for patients receiving dose escalated 3D conformal radiation therapy.Urol Oncol. 2004; 22: 165-168
- Rectal wall sparing effect of three different endorectal balloons in 3D conformal and IMRT prostate radiotherapy.Int J Radiat Oncol Biol Phys. 2005; 63: 565-576
- Reduced late rectal mucosal changes after prostate three-dimensional conformal radiotherapy with endorectal balloon as observed in repeated endoscopy.Int J Radiat Oncol Biol Phys. 2007; 67: 799-811
- The impact of varying volumes in rectal balloons on rectal dose sparing in conformal radiation therapy of prostate cancer. A prospective three-dimensional analysis.Strahlenther Onkol. 2005; 181: 709-716
- Organ movements and dose exposures in teletherapy of prostate cancer using a rectal balloon.Strahlenther Onkol. 2007; 183: 617-624
- IMRT versus conventional 3DCRT on prostate and normal tissue dosimetry using an endorectal balloon for prostate immobilization.Med Dosim. 2005; 30: 69-75
- Proton radiation as boost therapy for localized prostatic carcinoma.JAMA. 1979; 241: 1912-1915
- Motion and shape change when using an endorectal balloon during prostate radiation therapy.Radiother Oncol. 2006; 81: 184-189
- Rectal dose-volume differences using proton radiotherapy and a rectal balloon or water alone for the treatment of prostate cancer.Int J Radiat Oncol Biol Phys. 2007; 69: 1110-1116
- Rectal wall sparing by dosimetric effect of rectal balloon used during intensity-modulated radiation therapy (IMRT) for prostate cancer.Med Dosim. 2005; 30: 25-30
- Anal wall sparing effect of an endorectal balloon in 3D conformal and intensity-modulated prostate radiotherapy.Radiother Oncol. 2009; 93: 131-136
- Target motion variability and on-line positioning accuracy during external-beam radiation therapy of prostate cancer with an endorectal balloon device.Strahlenther Onkol. 2006; 182: 531-536
- Target repositioning optimization in prostate cancer: is intensity-modulated radiotherapy under stereotactic conditions feasible?.Int J Radiat Oncol Biol Phys. 2004; 59: 366-371
- Radiation proctopathy in the treatment of prostate cancer.Int J Radiat Oncol Biol Phys. 2006; 66: 1294-1305
- Cluster model analysis of late rectal bleeding after IMRT of prostate cancer: a case-control study.Int J Radiat Oncol Biol Phys. 2006; 64: 1255-1264
- A systematic evaluation of air cavity dose perturbation in megavoltage x-ray beams.Med Phys. 2000; 27: 1011-1017
- Dose perturbation by air cavities in megavoltage photon beams: implications for cavity surface doses.Australas Radiol. 2001; 45: 205-210
- Proctitis after external-beam radiotherapy for prostate cancer classified by Vienna Rectoscopy Score and correlated with EORTC/RTOG score for late rectal toxicity: results of a prospective multicenter study of 166 patients.Int J Radiat Oncol Biol Phys. 2007; 67: 78-83
- Moderate risk-adapted dose escalation with three-dimensional conformal radiotherapy of localized prostate cancer from 70 to 74 Gy. First report on 5-year morbidity and biochemical control from a prospective Austrian-German multicenter phase II trial.Strahlenther Onkol. 2009; 185: 94-100
- Acute gastrointestinal, genitourinary, and dermatological toxicity during dose-escalated 3D-conformal radiation therapy (3DCRT) using an intrarectal balloon for prostate gland localization and immobilization.Int J Radiat Oncol Biol Phys. 2005; 62: 392-396
- A prospective evaluation of rectal bleeding after dose-escalated three-dimensional conformal radiation therapy using an intrarectal balloon for prostate gland localization and immobilization.Urology. 2006; 67: 780-784
- Proton therapy for prostate cancer: the initial Loma Linda University experience.Int J Radiat Oncol Biol Phys. 2004; 59: 348-352
- Intensity modulated radiation therapy (IMRT) following prostatectomy: more favorable acute genitourinary toxicity profile compared to primary IMRT for prostate cancer.Int J Radiat Oncol Biol Phys. 2001; 49: 465-472
- 3-D Conformal radiotherapy of localized prostate cancer within an Austrian-German multicenter trial: a prospective study of patients’ acceptance of the rectal balloon during treatment.Wien Klin Wochenschr. 2006; 118: 224-229
- Tolerance of endorectal balloon in 396 patients treated with intensity-modulated radiation therapy (IMRT) for prostate cancer.Am J Clin Oncol. 2006; 29: 8-11
- Patient tolerance of rectal balloons in conformal radiation treatment of prostate cancer.Int J Radiat Oncol Biol Phys. 2006; 64: 1367-1370
- Set-up errors due to endorectal balloon positioning in intensity modulated radiation therapy for prostate cancer.Radiother Oncol. 2007; 84: 177-184
- Changes in prostate shape and volume and their implications for radiotherapy after introduction of endorectal balloon as determined by MRI at 3T.Int J Radiat Oncol Biol Phys. 2009; 73: 1446-1453
- Impact of setup uncertainty in the dosimetry of prostate and surrounding tissues in prostate cancer patients treated with Peacock/IMRT.Med Dosim. 2005; 30: 1-7
- Impact of endorectal balloon in the dosimetry of prostate and surrounding tissues in prostate cancer patients treated with IMRT.Med Dosim. 2007; 32: 281-286
- Monte Carlo calculation of rectal dose when using an intrarectal balloon during prostate radiation therapy.Med Dosim. 2007; 32: 151-156
- Observations on real-time prostate gland motion using electromagnetic tracking.Int J Radiat Oncol Biol Phys. 2008; 71: 1084-1090
- Fractionated stereotactic radiotherapy boost for gynecologic tumors: an alternative to brachytherapy?.Int J Radiat Oncol Biol Phys. 2005; 62: 118-124
Article info
Publication history
Published online: May 07, 2010
Accepted:
April 7,
2010
Received in revised form:
January 21,
2010
Received:
June 16,
2009
Identification
Copyright
© 2010 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
