Breast, chest wall, and nodal irradiation with prone set-up: Results of a hypofractionated trial with a median follow-up of 35 months

Shin, S.; No, H.J.; Vega, R. Mailhot; Fenton-Kerimian, M.; Maisonet, O.G.; Hitchen, C.; DeWyngaert, J. Keith; Formenti, Silvia C.

doi:10.1016/j.prro.2015.10.022

Cited by 31 publications

(24 citation statements)

References 37 publications

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“…This study confirms the existing evidence of lowered ipsilateral lung doses in prone position, and adds to the smaller body of evidence that this benefit persists even when treating the regional lymph nodes [8, 10–12, 18, 20–22, 30, 32]. Exposure of the lung to radiotherapy increases the risk of second-primary lung cancer (SPLC) development and death [33–35].…”

Section: Discussionsupporting

confidence: 82%

“…Shin et al [20] have reported on LNI in prone, with concomitant WBI or chest wall irradiation. To our knowledge, this is the only clinical data reporting on prone LNI.…”

Section: Discussionmentioning

confidence: 99%

“…Shin et al [20] report lower doses to the heart and ipsilateral lung, but over half of their patients had right sided breast cancer. They also limited LNI to level III-IV.…”

Section: Discussionmentioning

confidence: 99%

“…Although some authors report dosimetrical data on regional nodal irradiation in prone position [18, 19], this indication has not seen the same shift towards prone irradiation as in WBI, and few data are available for clinical implementation [20]. …”

Section: Introductionmentioning

confidence: 99%

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Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

et al. 2017

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BackgroundProne whole breast irradiation (WBI) leads to reduced heart and lung doses in breast cancer patients receiving adjuvant radiotherapy. In this feasibility trial, we investigated the prone position for whole breast + lymph node irradiation (WB + LNI).MethodsA new support device was developed for optimal target coverage, on which patients are positioned in a position resembling a phase from the crawl swimming technique (prone crawl position). Five left sided breast cancer patients were included and simulated in supine and prone position. For each patient, a treatment plan was made in prone and supine position for WB + LNI to the whole axilla and the unoperated part of the axilla. Patients served as their own controls for comparing dosimetry of target volumes and organs at risk (OAR) in prone versus in supine position.ResultsTarget volume coverage differed only slightly between prone and supine position. Doses were significantly reduced (P < 0.05) in prone position for ipsilateral lung (Dmean, D2, V5, V10, V20, V30), contralateral lung (Dmean, D2), contralateral breast (Dmean, D2 and for total axillary WB + LNI also V5), thyroid (Dmean, D2, V5, V10, V20, V30), oesophagus (Dmean and for partial axillary WB + LNI also D2 and V5), skin (D2 and for partial axillary WB + LNI V105 and V107). There were no significant differences for heart and humeral head doses.ConclusionsProne crawl position in WB + LNI allows for good breast and nodal target coverage with better sparing of ipsilateral lung, thyroid, contralateral breast, contralateral lung and oesophagus when compared to supine position. There is no difference in heart and humeral head doses.Trial registrationNo trial registration was performed because there were no therapeutic interventions.

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Section: Discussionsupporting

confidence: 82%

“…Shin et al [20] have reported on LNI in prone, with concomitant WBI or chest wall irradiation. To our knowledge, this is the only clinical data reporting on prone LNI.…”

Section: Discussionmentioning

confidence: 99%

“…Shin et al [20] report lower doses to the heart and ipsilateral lung, but over half of their patients had right sided breast cancer. They also limited LNI to level III-IV.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

et al. 2017

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“…There were no cases of brachial plexopathy, and the reconstruction complication rate was similar to that seen with standard fractionation . Another study of 69 patients who received hypofractionated RNI delivered in the prone position (40.5 Gy in 15 fractions with a concurrent daily boost of 0.5 Gy to the tumor bed) showed excellent locoregional control with favorable late effects and no cases of brachial plexopathy . A recently published randomized study from the Chinese Academy of Medical Sciences compared hypofractionated PMRT with RNI (43.5Gy in 15 fractions) to standard fractionation (50Gy in 25 fractions) without a scar boost.…”

Section: Future Directionsmentioning

confidence: 72%

The evolution of adjuvant radiation therapy for early‐stage and locally advanced breast cancer

Ohri

Haffty

2019

Breast J

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Adjuvant radiation therapy is often delivered after breast cancer surgery, both in the post-lumpectomy and post-mastectomy settings. Standard fractionation whole breast irradiation (SF-WBI), which is typically delivered over 5-7 weeks, was previously considered the standard of care. More recent data has helped to establish hypofractionated whole breast irradiation (HF-WBI), which consists of a 3-4 week regimen, as a new standard of care. This article provides an overview of the major randomized trials that support the routine use of HF-WBI for the majority of patients undergoing breast-conserving surgery for early-stage breast cancer. Newer data on the use of a hypofractionated approach in the post-mastectomy setting, as well as ongoing randomized trials addressing this topic, are also discussed. K E Y W O R D Saccelerated partial breast irradiation, breast cancer, breast-conserving therapy, hypofractionation, lumpectomy, post-mastectomy radiation, standard fractionation

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Potential benefits of crawl position for prone radiation therapy in breast cancer

Boute

Neve

Speleers

et al. 2017

J Applied Clin Med Phys

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PurposeTo investigate crawl position with the arm at the treated side alongside the body and at the opposite side above the head for prone treatment in patients requiring breast and regional lymph node irradiation.MethodsPatient support devices for crawl position were built for CT simulation and treatment. An asymmetric fork design resulted from an iterative process of prototype construction and testing. The fork's large horn supports the hemi‐thorax, shoulder, and elevated arm at the nontreated side and the head. The short, narrow horn supports the arm at the treated side. Between both horns, the treated breast and its regional lymph nodes are exposed. Endpoints were pain, comfort, set‐up precision, beam access to the breast and lymph nodes, and plan dose metrics. Pain and comfort were tested by volunteers (n = 9); set‐up precision, beam access, and plan dose metrics were tested by means of a patient study (n = 10). The AIO™ (Orfit, Wijnegem, Belgium) prone breastboard (AIO™) was used as a reference regarding comfort and set‐up precision.ResultsPain at the sternum, the ipsilateral shoulder, upper arm, and neck was lower in crawl position than with bilateral arm elevation on AIO™. Comfort and set‐up precision were better on the crawl prototype than on AIO™. In crawl position, beam directions in the coronal and near‐sagittal planes have access to the breast or regional lymph nodes without traversing device components. Plan comparison between supine and crawl positions showed better dose homogeneity for the breast and lymph node targets and dose reductions to all organs at risk for crawl position.ConclusionsRadiation therapy for breast and regional lymph nodes in crawl position is feasible. Good comfort and set‐up precision were demonstrated. Planning results support the hypothesis that breast and regional lymph nodes can be treated in crawl position with less dose to organs at risk and equal or better dose distribution in the target volumes than in supine position. The crawl technique is a candidate methodology for further investigation for patients requiring breast and regional lymph node irradiation.

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Breast, chest wall, and nodal irradiation with prone set-up: Results of a hypofractionated trial with a median follow-up of 35 months

Cited by 31 publications

References 37 publications

Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

The evolution of adjuvant radiation therapy for early‐stage and locally advanced breast cancer

Potential benefits of crawl position for prone radiation therapy in breast cancer

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