To prep or not to prep - that is the question: A randomized trial on the use of anti-flatulent medication as part of bowel preparation for patients having image-guided external-beam radiotherapy to the prostate

Publication date: Available online 4 November 2017
Source:Practical Radiation Oncology
Author(s): Merrylee McGuffin, Naila Devji, Lyann Kehoe, Anne Carty, Steve Russell, Lisa Di Prospero, Carlo DeAngelis, Alex Kiss, Danny Vesprini, Andrew Loblaw, Laura D'Alimonte
IntroductionRadiation therapy is a standard treatment option for prostate cancer. With growing use of escalated doses and tighter margins, procedures to limit rectal size variation are needed to reduce prostate motion, increase treatment accuracy and minimize rectal toxicity. This prospective study was done to determine whether the introduction of an anti-flatulent medication would decrease rectal distention at CT simulation and throughout a course of radiation therapy.Methods and MaterialsPatients undergoing a radical course of radiotherapy to the prostate/prostate bed were eligible to participate. Participants were randomly assigned to the intervention arm (anti-flatulent medication) or the control arm (no medication). For each participant, the number of CT simulation rescans was recorded. Rectal diameters were measured on CT simulation and treatment CBCT scans. Acute rectal toxicities were assessed at baseline and weekly using NCI CTCAE v4.0. Chi-square analysis was used to compare the number of participants requiring a rescan in each study arm. Change in rectal diameter over time was assessed using repeated measures ANOVA.ResultsA total of 78 patients participated, with equal numbers assigned to each study arm. There was no significant difference between arms in the number of participants requiring a CT simulation rescan (p=0.5551). There was no significant variation in rectal diameter between arms (p=0.8999). However, there was a significant effect of time (p=0.0017) and a significant interaction effect between study arm and time on rectal diameter (p=0.0141). No acute rectal toxicities above grade 2 were reported.ConclusionsThe addition of anti-flatulent medication did not affect the frequency of CT simulation rescans. Both time and the interaction between study arm and time had a statistically significant effect on rectal diameter, though neither finding was clinically significant. Instead, standardized bowel preparation education developed for this study may have been sufficient to limit rectal size variation.



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