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

Abstract

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.

External-beam partial breast irradiation in a supine versus prone position after breast-conserving surgery for Chinese breast cancer patients

“…Deseyne et al . 16 also confirmed that for patients who underwent WBI, a small but statistically significant difference was evident in the whole breast CTV between the prone and supine positions (57 cc lower in the prone position). However, for patients with small breasts (<750 cm 3 ) who underwent radiotherapy in the prone position, no obvious variations in the breast target volume were found between the supine and prone positions 17 .…”

“…Breast and regional lymph nodes can be treated with an equal or better dose distribution in the target volumes in the prone position than in the supine position. For patients treated with WBI, target volume coverage differed only slightly between the prone and supine positions 16 . To the best of our knowledge, our study on the comparison of dosimetric parameters between the prone and supine positions is the first the address the topic using 3DCRT EB-PBI; moreover, the dose distribution discrepancy correlations have also not been investigated previously.…”

The relation between patient discomfort and uncompensated forces of a patient support device for breast and regional lymph node radiotherapy

“…V9 was used for a pilot study which compared five patient treatment simulations in supine and prone crawl position. This study demonstrates that the patients, positioned on the prone crawl device, have favourable properties of sparing vital organs and good breast and nodal target coverage compared to the supine position (Deseyne et al, 2017).…”

“…treated side of the patient is positioned lower. The ipsilateral breast is hanging through the device which is suspended over the table, resulting in excellent radiotherapeutic anatomy and beam access for WBI + LNI (Mulliez et al, 2013b;Deseyne et al, 2017). Volunteers were asked to lie immobile for at least 10 min.…”

Characterization of Respiration-Induced Motion in Prone Versus Supine Patient Positioning for Thoracic Radiation Therapy

“…Particularly for largebreasted patients, the face-down orientation enables superior lung and chest wall dose sparing. [10][11][12][13][14][15][16][17][18][19][20][21][22][23] Cosmetic outcomes have also been reported to improve with the prone position compared with patients treated supine. 16,24,25 Some investigations have demonstrated reduced skin toxicity, 24,26 whereas others have reported opposite effects.…”