Abdominal pillow for the sparing of small bowel in four-field conventional pelvic radiotherapy.

From 2003 through 2004, 88 patients with gynecological cancer were referred to Istanbul University Oncology Institute for pelvic radiation therapy. All patients underwent small bowel evaluation within the pelvic radiotherapy field in both the supine and prone positions with and without an abdominal pillow. The small bowel area included in radiation fields and intestinal movement were compared on PA films. All patients were treated by using the abdominal pillow. The median external beam pelvic radiation dose of 5040cGy (range, 3220-5400cGy) was administered. The mean distance of upward displacement of small bowel in the prone position on abdominal pillow compared with in the prone position alone and in the supine position was 3.6 cm (range, 0-14 cm) and 4.7 cm (range, 0-14 cm). Using the abdominal pillow, the mean small bowel area was reduced by 45% and 55% compared to the prone position alone and the supine position, respectively (p = 0.0001). In patients who had pelvic surgery intestinal movement was significantly reduced. The incidence of G1, G2 and G3 acute radiation toxicity was 18%, 36% and 3%, respectively. This study demonstrates that the small intestines can be displaced out of the radiation field by an abdominal pillow in the prone position. Also, this noninvasive technique provides for reduction of acute gastrointestinal morbidity.