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November 3, 2021
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Article

The usefulness of fleet rectal enemas on high-dose-rate intracavitary cervical cancer brachytherapy. A prospective trial

Publicated to:Journal Of Contemporary Brachytherapy. 9 (3): 224-229 - 2017-05-01 9(3), DOI: 10.5114/jcb.2017.68135

Authors: Andres, Ignacio; Gutierrez-Perez, Manuel; Pilar Rodriguez-Vela, Maria; Berenguer, Roberto; Sevillano, Marimar; Aguayo, Manuel; Arenas, Meritxell; Rovirosa, Angeles; Murria-Perez, Yashmina; Sabater, Sebastia

Affiliations

CHUA, Dept Radiat Oncol, C Hnos Falco 37, Albacete 02006, Spain - Author
Hosp Univ St Joan, Dept Radiat Oncol, Reus, Spain - Author
Univ Barcelona, Gynecol Canc Unit, Radiat Oncol Dept, ICMHO,Hosp Clin,IDIBAPS, Barcelona, Spain - Author

Abstract

Purpose: To evaluate the effects of rectal enemas on rectal doses during radical high-dose-rate (HDR) intracavitary cervical brachytherapy (BT). Material and methods: Twenty patients suffering from cervical cancer and treated with external beam radiotherapy and HDR-BT were included in a prospective trial. The first brachytherapy fraction was considered the basal status, and patients were instructed to self-administer two rectal cleansing enemas before the second fraction. Dose-volume histogram (DVH) values were generated for the rectum and correlated with rectal volume variation. Brachytherapy was carried out with a Fletcher or Utrecht applicator. Results: No significant rectal volume differences were observed between fractions with or without rectal enemas (without, 52.64 +/- 15.92 cc; with, 53.16 +/- 19.28 cc). There was a significant correlation between both rectal volumes (r = 0.722, p = 0.001). No significant differences were observed in analyzed DVH parameters (median values: Delta D-0.1cc, 4.17 vs. 3.61 Gy; Delta D-1cc, 3.23 vs. 2.87 Gy; Delta D-2cc 2.9 vs. 2.54 Gy; Delta D-5cc, 2.35 vs. 2.05 Gy, for no enema and enema fraction, respectively). No significant rectal volume differences nor DVH parameter differences were observed according the applicator type. Conclusions: Our rectal enemas protocol prior to HDR-BT was ineffective in significantly modifying rectal DVH parameters. No differences were observed according to the type of applicator used.

Keywords

AccumulationBody-mass indexCarcinomaCervical brachytherapyCervical cancerComplicationsComputed-tomographyDose-volume histogramMriRadiotherapyRectal enemaRegistrationToxicityVaginal cuff brachytherapy

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Contemporary Brachytherapy due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2017, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Radiology, Nuclear Medicine and Imaging.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 2.48, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-17, the following number of citations:

  • WoS: 10
  • Europe PMC: 5

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-17:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 14.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 16 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 0.25.
  • The number of mentions on the social network Facebook: 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.