From the Guidelines
The radiation bed for the Nigro protocol typically involves a radiation dose of 45 Gy in 20 or 25 fractions over 4 or 5 weeks using external-beam irradiation, as established in the UKCCCR Anal Cancer Trial I phase III randomized clinical trial 1. The Nigro protocol is a standard treatment approach for anal cancer, combining radiation therapy with concurrent chemotherapy consisting of 5-fluorouracil and mitomycin C.
- Key aspects of the radiation bed for the Nigro protocol include:
- Radiation dose: 45 Gy in 20 or 25 fractions over 4 or 5 weeks
- Radiation technique: external-beam irradiation
- Chemotherapy: 5-fluorouracil and mitomycin C
- Patient positioning: prone on a belly board or supine with a customized immobilization device
- The prone position on a belly board is often preferred as it allows the small bowel to fall away from the pelvis, reducing radiation exposure to healthy tissue and minimizing side effects, as supported by the UKCCCR Anal Cancer Trial I phase III randomized clinical trial 1.
- Modern radiation techniques such as intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) are typically used with these positioning devices to precisely target the tumor while sparing surrounding normal tissues.
- Proper immobilization is crucial for accurate radiation delivery and reproducibility of the treatment position across multiple sessions, as emphasized in the NCCN clinical practice guidelines for anal carcinoma 1.
From the Research
Radiation Bed for Nigro Protocol
- The Nigro protocol typically involves a combination of radiation therapy and chemotherapy, but the specific details of the radiation bed are not explicitly mentioned in the provided studies 2, 3, 4, 5, 6.
- However, the studies do mention the use of external beam radiation therapy, with doses ranging from 45-50 Gy 5 to 59.4 Gy 6, and fractionation schemes such as 1.8 Gy fractions 6 or 10 fractions 3.
- The radiation therapy is often combined with chemotherapy agents like 5-fluorouracil and mitomycin C, which are administered through various routes, including intravenous bolus injection 5 or continuous infusion 6.
- The studies do not provide specific information on the radiation bed itself, but rather focus on the efficacy and toxicity of the combined radiation and chemotherapy regimens for various types of cancer, including squamous cell bladder cancer 2, oesophageal squamous carcinoma 3, vulvar squamous cell carcinoma 4, locally recurrent rectal carcinoma 5, and locally advanced adenocarcinoma of the pancreas 6.