Treating prostate patients with radiation therapy in the upright position shows “promise”
Research highlights the benefits of imaging and treatment for prostate patients in the upright rather than supine position
A newly-published paper has shown that treating prostate patients with radiation therapy in the upright position appears to hold “promising” advantages.
The study to investigate the positions and orientations of the male pelvic organs between the supine and upright positions focused on 15 volunteers aged 55-75.
Each were scanned on a 0.6 T Fonar MRI scanner in the supine and upright positions with a full bladder and also with an empty bladder in the upright position.
With a growing acceptance in radiation oncology and radiology that treating and imaging patients in the upright orientation may have distinct advantages over the recumbent position, the Pelvic study revealed that in the upright position the:
position and shape of the prostate is not impacted significantly by bladder fill;
distance between the sacrum and the anterior bladder wall is significantly smaller;
Anterior-Posterior length and the bladder width is significantly larger;
seminal vesicles are pushed down by the bladder;
top of the penile bulb is further away from the apex of the prostate.
The study, conducted by a team led by Dr. Niek Schreuder, suggested that the observed differences could positively impact upright prostate treatments.
The study revealed that in the upright position, the risk of the small bowel approximating the treatment volume is reduced; that prostate treatments can be done with a reduced focus on bladder fill; that radiation beams for treating intermediate risk prostrate can be made smaller, or that a larger portion of the seminal vesicles can be treated with the same beam size than typically used for supine treatments; and that the average dose to the penile bulb could be reduced since the latter is further away from the prostate.
The findings from the study, Anatomical Changes in the Male Pelvis between the Supine and Upright Positions: A Feasibility Study for Prostate Treatments in the Upright Position, are now published in the Journal of Applied Clinical Medical Physics (JACMP) – see http://doi.org/10.1002/acm2.14099
The authors noted that while treating patients in the upright position using external beam radiation therapy has “a long history,” external beam radiation therapy shifted towards treating patients in the supine position in the early 1980s following the advent of CT scanning “to match the position in which the CT images were acquired.”
However, more recent research has begun to “address the benefits and possible advantages of upright treatments and the rationale to re-consider treating patients in the upright orientation again.”
Schreuder’s team suggest a key benefit is less organ movement, potentially facilitating more accurate targeting of treatment.
Schreuder, who is Chief Scientific Officer for Leo Cancer Care - which manufactures upright radiotherapy solutions - explained the goal of the work was to answer the question whether it was feasible to treat the prostate in the upright position based on the possible anatomical changes in the male pelvis between the recumbent and upright positions.
“The study revealed that the anatomical changes in the male pelvis could potentially favour the upright position for prostate treatments,” he said.
“The increased downward pressure from the abdominal contents on the bladder and prostate in the upright position appears to have a stabilization effect on the prostate since the changes in bladder fill did not impact the prostate position and orientation in the same manner as reported in the literature for the supine position.
“This holds great promise for upright prostate treatments removing the burden of a reproducing the bladder volume at the time of the CT scan.”
The paper stated that “concerns about prostate movements during treatment in the upright position might be reduced or even eliminated.”
“There was nothing observed in this study of the male pelvic anatomy, that would prevent prostate treatments in the upright orientation,” say the authors.
Please Note: The Leo Cancer Care technology is not commercially available and will not treat patients until the required regulatory approval has been achieved.
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