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Abstract

Large pendulous breasts pose particular challenges in stabilisation for radiotherapy, due to their inherent mobility. To ensure reproducibility of their positioning between fractions, customised breast immobilisation devices are designed to improve stabilisation and minimise toxicities to the skin and underlying lung. This study aims to review current methods of immobilisation for tangential treatment techniques to the large breast, assessing the range of devices commonly used and discover if any one technique can be recommended. A survey containing 13 questions was sent to 42 randomly-selected centres performing tangential treatments for breast cancer. The questions were designed to assess each centre's opinion on the effectiveness of the immobilisation device and reproducibility of the breast position for patients with large pendulous breasts. Centres graded their responses using a Likert scale of 1-5, 1 being most effective to 5 being the least effective outcome. Additionally, centres were asked to identify if their current system had any advantages/disadvantages. Ten immobilisation devices were identified from 18 responses to the survey. The prone technique was the most popular, practiced by 22% of respondents. It also ranked consistently well over all in the questions from the survey. The breast board, thermoplastic mask, wireless bra, breast cups, Micropore tape™ (Livingstone International Pty Ltd, Rosebury, NSW, Australia), Vac fix ® (S & S Technology, Houston, Texas, USA), stockings, breast rings and plastic L-shaped supports were other devices identified by respondents. None of these other techniques were graded consistently well over the range of survey questions compared with the prone technique. Those using the prone technique were most satisfied with its effectiveness for patients with large pendulous breasts, however, it is acknowledged that the technique is not suitable for all patients.