Effect of bra use during radiation therapy for large-breasted women: Acute toxicity and treated heart and lung volumes

Abstract

Purpose Large breast size presents special problems during radiation simulation, planning and patient treatment, including increased skin toxicity, in women undergoing breast-conserving surgery and radiotherapy (BCT). We report our experience using a bra during radiation in large-breasted women and its effect on acute toxicity and heart and lung dosimetry. Materials and methods From 2001 to 2006, 246 consecutive large-breasted women (bra size ≥ 38 and/or ≥ D cup) were treated with BCT using either 3D conformal (3D-CRT) or Intensity Modulated Radiation (IMRT). In 58 cases, at the physicians’ discretion, a custom-fit bra was used during simulation and treatment. Endpoints were acute radiation dermatitis, and dosimetric comparison of heart and lung volumes in a subgroup of 12 left-sided breast cancer patients planned with and without a bra. Results The majority of acute skin toxicities were grade 2 and were experienced by 90% of patients in a bra compared to 70% of patients not in a bra (p=0.003). On multivariate analysis significant predictors of grade 2/3 skin toxicity included 3D-CRT instead of IMRT (OR=3.9, 95% CI:1.8-8.5) and the use of a bra (OR=5.5, 95% CI:1.6-18.8). For left-sided patients, use of a bra was associated with a volume of heart in the treatment fields decreased by 63.4% (p=0.002), a volume of left lung decreased by 18.5% (p=0.25), and chest wall separation decreased by a mean of 1 cm (p=0.03). Conclusions The use of a bra to augment breast shape and position in large-breasted women is an alternative to prone positioning and associated with reduced chest wall separation and reduced heart volume within the treatment field.

A systematic review of methods to immobilise breast tissue during adjuvant breast irradiation

“…A final study investigated the benefits of treating women with large breasts in a commercially available bra/bustier (31). The authors assessed rate of acute radiation dermatitis as the primary endpoint, no accuracy or reproducibility data was collected.…”

Cardiac-sparing radiation therapy using positioning breast shell for patients with left-sided breast cancer who are ineligible for breath-hold techniques

“…Keller et al investigated the benefit of using a bra to augment breast shape and position in women with large breasts undergoing ABRT. 13 The study endpoint was acute radiation dermatitis, and 90% of patients with a bra developed only grade 2 skin toxicity. None of our patients developed grade ≥3 skin toxicity.…”

Skin recurrence in the radiation treatment of breast cancer

“…Fourth, in patients with a very superficial tumor bed, prone positioning may not be appropriate given the frequent difficulty in achieving optimal surface dosing. Alternatively, boosting these patients in the supine position with a bolus or personal bra 29 may be desirable to increase the dose to the tumor bed and overlying tissue. Finally, the use of a boost in younger patients lowers the risk of local recurrence and should not be omitted.…”