Whole-breast irradiation: a subgroup analysis of criteria to stratify for prone position treatment

Ramella, Sara; Trodella, Lucio; Ippolito, Edy; Fiore, Michele; Cellini, Francesco; Stimato, Gerardina; Gaudino, Diego; Greco, Carlo; Ramponi, Sara; Cammilluzzi, Eugenio; Cesarini, Claudio; Piermattei, Angelo; Cesario, Alfredo; D’Angelillo, Rolando Maria

doi:10.1016/j.meddos.2011.06.010

Cited by 18 publications

(22 citation statements)

References 29 publications

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“…Due to the changes of the shape of the irradiated breast, however, in accordance with our previous findings,3 the dose inhomogeneity within the target volume was higher in the prone position, which may be considered as a disadvantage of the technique. Similarly, despite the different dose-prescription strategy and the use of the field-in-field technique in the prone position only, worse homogeneity index values and larger maximum dose, indicating greater dose inhomogeneity, were found in the prone position in the dosimetric study of Ramella et al33…”

Section: Discussionmentioning

confidence: 93%

Radiation dose to the nodal regions during prone versus supine breast irradiation

Csenki¹,

Újhidy²,

Cserháti³

et al. 2014

TCRM

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BackgroundProne positioning for breast radiotherapy is preferable when the aim is a reduction of the dose to the ipsilateral lung or the heart in certain left-sided cases.Materials and methodsIn 100 breast cancer cases awaiting postoperative whole-breast radiotherapy, conformal radiotherapy plans were prospectively generated in both prone and supine positions. The axillary nodal region (levels I–III) and internal mammary (IM) lymph-node region in the upper three intercostal spaces were retrospectively contoured. The mean doses to the nodal regions and the volume receiving 25 Gy (V25Gy), V45Gy, and V47.5Gy were compared between the two treatment positions.ResultsIn most cases, the doses to axillary levels I–III and the IM lymph nodes were inadequate, regardless of the treatment position. The nodal doses were significantly lower in the prone than in the supine position. The radiation doses to levels II–III and IM nodes were especially low. The V45Gy and V47.5Gy of the level I axillary lymph nodes were 54.6% and 40.2%, respectively, in the supine, and 3.0% and 1.7%, respectively, in the prone position. In the supine position, only 17 patients (17%) received a mean dose of 45 Gy to the axillary level I nodes.ConclusionThe radiation dose to the axillary and IM lymph nodes during breast radiotherapy is therapeutically insufficient in most cases, and is significantly lower in the prone position than in the supine position.

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Section: Discussionmentioning

confidence: 93%

Radiation dose to the nodal regions during prone versus supine breast irradiation

Csenki¹,

Újhidy²,

Cserháti³

et al. 2014

TCRM

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“…Prone set-up yields the same advantages of lateral decubitus RT with a simpler set-up and better accuracy. Moreover, several studies have investigated prone RT where dosimetric studies 22,28 showed increased homogeneity and reduced lung doses with prone positioning in comparison with supine positioning, whereas in a large single-centre study by Stegman et al, 29 that reviewed the data of 245 patients treated over a 12-year period, planning was with opposed coplanar beams and the median hot spot percentage was 106% (interquartile range 104-108%) in the majority of cases.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 Prone position had been used in order to reduce the dose received by normal tissues and the size of hot spots. 21,22 However, coexisting large or pendulous breasts and high BMI make this kind of approach difficult because of some positioning complications.…”

Section: Introductionmentioning

confidence: 99%

A new three-dimensional conformal radiotherapy (3DCRT) technique for large breast and/or high body mass index patients: evaluation of a novel fields assessment aimed to reduce extra–target-tissue irradiation

Gerardina¹,

I²,

Sonia³

et al. 2016

BJR

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Objective: To develop an alternative three-dimensional treatment plan with standardized fields class solution for whole-breast radiotherapy in patients with large/ pendulous breast and/or high body mass index (BMI). Methods: Two treatment plans [tangential fields and standardized five-fields technique (S5F)] for a total dose of 50 Gy/25 fractions were generated for patients with large breasts [planning target volume (PTV) .1000 cm 3 and/or BMI .25 kg m 22 ], supine positioned. S5F plans consist of two wedged tangential beams, anteroposterior: 20°for the right breast and 340°for the left breast, and posteroanterior: 181°for the right breast and 179°for the left breast. A field in field in medial-lateral beam and additional fields were added to reduce hot spot areas and extra-target-tissue irradiation and to improve dose distribution. The percentage of PTV receiving 95% of the prescribed dose (PTV V 95% ), percentage of PTV receiving 105% of the prescribed dose (PTV V 105% ), maximal dose to PTV (PTV D max ), homogeneity index (HI) and conformity index were recorded. V 10% , V 20% , V 105% and V 107% of a "proper" normal tissue structure (body-PTV healthy tissue) were recorded. Statistical analyses were performed using SYSTAT v.12.0 (SPSS, Chicago, IL). Results: In 38 patients included, S5F improved HI (8.4 vs 10.1; p # 0.001) and significantly reduced PTV D max and PTV V 105% . The extra-target-tissue irradiation was significantly reduced using S5F for V 105% (cm 3 ) and V 107% (cm 3 ) with a very high difference in tissue irradiation (46.6 vs 3.0 cm 3 , p # 0.001 for V 105% and 12.2 vs 0.0 cm 3 , p # 0.001 for V 107% for tangential field and S5F plans, respectively). Only a slight increase in low-dose extra-target-tissue irradiation (V 10% ) was observed (2.2719 vs 1.8261 cm 3 , p 5 0.002). Conclusion: The S5F technique in patients with large breast or high BMI increases HI and decreases hot spots in extra-target-tissues and can therefore be easily implemented in breast cancer radiotherapy. Advances in knowledge: The treatment planning strategy proposed in this study has several advantages: (a) it is extremely reliable as the standard supine positioning is used; (b) the standardized class solution allows for widespread use; (c) time and cost of treatment are not increased; and (d) it can be used for both large breasted and obese patients not compliant to different treatment positioning.

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“…Treatment planning studies have demonstrated the dosimetric benefits of prone breast irradiation for all women, regardless of breast size [19]. Prone positioning increases the anatomic distance of the breast from the heart and lungs, eliminates the bolus effect created by the inframammary fold, and improves dose homogeneity as compared to WBI in the prone position.…”

Section: Introductionmentioning

confidence: 99%

Axillary lymph node dose with tangential whole breast radiation in the prone versus supine position: a dosimetric study

et al. 2012

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BackgroundProne breast positioning reduces skin reaction and heart and lung dose, but may also reduce radiation dose to axillary lymph nodes (ALNs).MethodsWomen with early stage breast cancer treated with whole breast irradiation (WBI) in the prone position were identified. Patients treated in the supine position were matched for treating physician, laterality, and fractionation. Ipsilateral breast, tumor bed, and Level I, II, and III ALNs were contoured according to the RTOG breast atlas. Clips marking surgically removed sentinel lymph nodes (SLN)s were contoured. Treatment plans developed for each patient were retrospectively analyzed. V90% and V95% was calculated for each axillary level. When present, dose to axillary surgical clips was calculated.ResultsTreatment plans for 46 women (23 prone and 23 supine) were reviewed. The mean V90% and V95% of ALN Level I was significantly lower for patients treated in the prone position (21% and 14%, respectively) than in the supine position (50% and 37%, respectively) (p < 0.0001 and p < 0.0001, respectively). Generally, Level II & III ALNs received little dose in either position. Sentinel node biopsy clips were all contained within axillary Level I. The mean V95% of SLN clips was 47% for patients treated in the supine position and 0% for patients treated in the prone position (p < 0.0001). Mean V90% to SLN clips was 96% for women treated in the supine position but only 13% for women treated in the prone position.ConclusionsStandard tangential breast irradiation in the prone position results in substantially reduced dose to the Level I axilla as compared with treatment in the supine position. For women in whom axillary coverage is indicated such as those with positive sentinel lymph node biopsy who do not undergo completion axillary dissection, treatment in the prone position may be inappropriate.

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Whole-breast irradiation: a subgroup analysis of criteria to stratify for prone position treatment

Cited by 18 publications

References 29 publications

Radiation dose to the nodal regions during prone versus supine breast irradiation

Radiation dose to the nodal regions during prone versus supine breast irradiation

A new three-dimensional conformal radiotherapy (3DCRT) technique for large breast and/or high body mass index patients: evaluation of a novel fields assessment aimed to reduce extra–target-tissue irradiation

Axillary lymph node dose with tangential whole breast radiation in the prone versus supine position: a dosimetric study

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