A simple clinical method for predicting the benefit of prone vs. supine positioning in reducing heart exposure during left breast radiotherapy

Kahán, Zsuzsanna; Rárosi, Ferenc; Gaál, Szilvia; Cserháti, Adrienn; Boda, Krisztina; Darázs, Barbara; Kószó, Renáta; Lakosi, Ferenc; Gulybán, Ákos; Coucke, Philippe; Varga, Zoltán

doi:10.1016/j.radonc.2017.12.021

Cited by 17 publications

(32 citation statements)

References 39 publications

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“…Others have shown an association between breast size and the benefit of prone positioning [8]. In our prospective clinical experiment, we found a strong relationship between the dose to the LAD and heart and some patient-related characteristics, such as BMI and the geography of the breast, heart and chest wall [6, 7].…”

Section: Introductionsupporting

confidence: 51%

“…A bootstrap method was applied to construct 95% confidence intervals for the net benefit at various threshold levels for the main effect model [7]. 1000 bootstrap samples were generated by Microsoft Excel with a sample size of 138 each.…”

Section: Resultsmentioning

confidence: 99%

“…This was the motivation for creating a model to predict the preferable position and anticipate the dose difference between the two positions using the patient-related characteristics noted above. In fact, this model is already being implemented in routine radiotherapy practice at the Department of Oncotherapy, University of Szeged, Szeged, Hungary; in this article, we describe the details of how model building and consequently validation of the best model took place [6 , 7 ] .…”

Section: Introductionmentioning

confidence: 99%

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Decision curve analysis apropos of choice of preferable treatment positioning during breast irradiation

Rárosi

Boda

Kahán

et al. 2019

BMC Med Inform Decis Mak

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BackgroundRadiotherapy is a standard treatment option for breast cancer, but it may lead to significant late morbidity, including radiation heart damage. Breast irradiation performed individually in the supine or prone position may aid in minimizing the irradiation dose to the heart and LAD coronary artery. A series of CT scans and therapy plans are needed in both positions for the ‘gold standard’ decision on the preferable treatment position. This method is expensive with respect to technology and physician workload.Our ultimate goal is to develop a predictive tool to identify the preferable treatment position using easily measurable patient characteristics. In this article, we describe the details of how model building and consequently validation of the best model are done.MethodsDifferent models were used: both logistic regression and multiple linear regressions were used to estimate the LAD mean dose difference (the difference between the mean dose to the LAD in the supine position versus prone position); predicted dose differences were analysed compared to the ‘gold standard’ values, and the best model was selected accordingly. The final model was checked by random cross-validation. In addition to generally used measures (ROC and Brier score), decision curves were employed to evaluate the performance of the models.ResultsROC analysis demonstrated that none of the predictors alone was satisfactory. Multiple logistic regression models and the linear regression model lead to high values of net benefit for a wide range of threshold probabilities. Multiple linear regression seemed to be the most useful model. We also present the results of the random cross-validation for this model (i.e. sensitivity of 80.7% and specificity of 87.5%).ConclusionsDecision curves proved to be useful to evaluate our models. Our results indicate that any of the models could be implemented in clinical practice, but the linear regression model is the most useful model to facilitate the radiation treatment decision. In addition, it is in use in everyday practice in the Department of Oncotherapy, University of Szeged, Hungary.

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Section: Introductionsupporting

confidence: 51%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Decision curve analysis apropos of choice of preferable treatment positioning during breast irradiation

Rárosi

Boda

Kahán

et al. 2019

BMC Med Inform Decis Mak

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“…Deep inspiration breath-hold (DIBH) and prone are widely used to improve cardiac dosimetry [6–15]. However, certain factors may preclude their use, such as intolerance of the technique by the patient or requirement for specialized equipment.…”

Section: Introductionmentioning

confidence: 99%

“…The reasons why patients may not be able to tolerate breath-hold include medical co-morbidity, anxiety, inability to tolerate specialized equipment, or language barriers. The benefits of the prone technique in cardiac sparing might be limited to large breasted women, and may in fact be detrimental in women with small breasts [15–18]. A novel free-breathing technique for left breast irradiation in the reverse semi-decubitus (RSD) position could benefit patients unable to tolerate breath-hold, by reducing the cardiac dose [19, 20].…”

Section: Introductionmentioning

confidence: 99%

Image-guided study of inter-fraction and intra-fraction set-up variability and margins in reverse semi-decubitus breast radiotherapy

et al. 2018

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BackgroundThis study aimed to evaluate the inter-fraction set-up error and intra-fraction motion during reverse semi-decubitus (RSD) breast radiotherapy, and to determine a planning target volume (PTV) margin.Material and methodsPre- and post-treatment cone-beam computed tomography (CBCT) scans were prospectively acquired at fractions 1, 4, 7, 8, 11, and 14 for 30 patients who underwent RSD breast radiotherapy. Online correction for initial set-up error greater than 5 mm or 2° was performed and post-correction CBCT was acquired. An off-line analysis was performed to quantify initial and residual inter-fraction set-up errors and intra-fraction motion in three-dimensions. Patient inter-fraction errors were analysed for time trends during the course of radiotherapy. PTV margins were calculated from the systematic and random errors.ResultsThe initial inter-fraction population systematic errors were 1.8–3.3 mm (translation) and 0.5° (rotation); random errors were 1.8–2.1 mm (translation) and 0.3–0.5° (rotation). After online correction, the residual inter-fraction population systematic errors were 1.2–1.8 mm (translation) and 0.3–0.4° (rotation); random errors were 1.4–1.6 mm (translation) and 0.3–0.4° (rotation). Intra-fraction population systematic and random errors were ≤ 1.3 mm (translation) and ≤ 0.2° (rotation). The magnitude of inter-fraction set-up errors in the anterior-posterior direction, roll, and yaw were significantly correlated with higher body weight and body mass index (BMI). The inter-fraction set-up error did not change significantly as a function of time during the course of radiotherapy. The magnitude of intra-fraction motion was not correlated with patient characteristics and treatment time. The total PTV margins accounting for pre-correction and intra-fraction errors were 6.5–10.2 mm; those accounting for post-correction and intra-fraction errors were 4.7–6.3 mm.ConclusionsCBCT is an effective modality to evaluate and improve the inter-fraction set-up reproducibility in RSD breast radiotherapy, particularly for patients with higher BMI. Intra-fraction motion was minimal during RSD breast radiotherapy.

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Modern Radiation Therapy Techniques and their Toxicities for Breast Cancer

Atiq¹,

Atiq²,

Naeem³

et al. 2022

Breast Cancer: From Bench to Personalized Medicine

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A simple clinical method for predicting the benefit of prone vs. supine positioning in reducing heart exposure during left breast radiotherapy

Abstract: We consider this simple clinical tool appropriate for assisting individual positioning aiming at maximum heart protection during left breast irradiation.

Cited by 17 publications

References 39 publications

Decision curve analysis apropos of choice of preferable treatment positioning during breast irradiation

Decision curve analysis apropos of choice of preferable treatment positioning during breast irradiation

Image-guided study of inter-fraction and intra-fraction set-up variability and margins in reverse semi-decubitus breast radiotherapy

Modern Radiation Therapy Techniques and their Toxicities for Breast Cancer

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