General dosing recommendations:
(1) Keep the radiation dose below 4,500 cGy if possible.
(2) Plan delivery using multiple fields based on conformal therapy and 3D planning.
(3) Use small bowel contrast studies to help determine optimum radiation fields.
(4) Consider use of radioprotective agents (Amifostine = WR-2721).
Pelvic radiation:
(1) Compression on the lower anterior abdominal wall (keeps the small bowel out of the pelvis).
(2) Different positioning techniques for keeping the small bowel away from pelvis (prone, Trendelenburg).
(3) Use an opening in the treatment table (belly board) so that a person's stomach is allowed to be lower while in the prone (face down) position.
(4) Procedural interventions to physically exclude the small bowel from the pelvis:
(4a) Omental, prosthetic spacers or mesh materials.
(4b) Temporary pneumoperitoneum
(4c) Distend the urinary bladder (keeps the small bowel out of pelvis). Exception: Patients with tumor in the bladder dome, since distention may move the tumor out of the radiation treatment field.
Intra-abdominal infection is a potential complication in using a prosthetic spacer or mesh.
Special problems for excluding small bowel from the pelvis in patients with previous surgery:
(1) adhesions after abdominoperitoneal resection
(2) omental resection (not available for exclusion procedures)
