Superior target volume and organ stability with the use of endorectal balloons in post-prostatectomy radiotherapy

We investigated the endorectal balloon (ERB) as a method to improve post-prostatectomy clinical target volume (CTV) stability. Seventy cone-beam CT (CBCT) obtained during radiotherapy treatment from seven patients treated with an ERB and 68 CBCT from seven patients treated without an ERB were contoured according to published guidelines. CTV was subdivided into superior and inferior CTV; whole rectal volume was subdivided into superior and inferior rectum and anal volume. Concordance index (CI) of CBCT treatment volumes compared with planning volumes was calculated and displacements were measured. Whole rectal, superior and inferior rectum and anal CI were significantly improved with the ERB by 21%, 17%, 26% and 17% respectively (P < 0.0001). Overall CTV and inferior CTV CI was improved by 4% with the ERB (overall CTV P = 0.021; Inferior CTV P < 0.0001). In the ERB cohort, average displacement for superior CTV was 0.37 cm anterior–posterior (AP) and 0.10 cm left–right (LR). Average standard deviation was 0.27 cm AP and 0.11 cm LR. Inferior CTV average displacement was 0.11 cm AP and 0.02 cm LR. Average standard deviation was 0.11 cm AP and 0.02 cm LR. In the non-ERB cohort, average displacement for superior CTV was 0.43 cm AP and 0.10 mm left–right (LR). Average standard deviation was 0.45 cm AP and 0.13 cm LR. Inferior CTV average displacement was 0.16 cm AP and 0.01 cm LR. Average standard deviation was 0.17 cm AP and 0.03 cm LR. There was no statistically significant impact of bladder filling on CTV CI in ERB patients (P = 0.551) as opposed to non-ERB patients (P = 0.0421). ERBs in the post-prostatectomy setting resulted in increased rectal and CTV stability while negating the effects of bladder filling on CTV stability.