Comparison of supine or prone crawl photon or proton breast and regional lymph node radiation therapy including the internal mammary chain

Speleers, Bruno; Belosi, Francesca; Gersem, Werner R. De; Deseyne, Pieter; Paelinck, Leen; Bolsi, Alessandra; Lomax, Antony; Boute, Bert; Greveling, Annick E. Van; Monten, Christel; Velde, Joris J. Van de; Vercauteren, Tom; Veldeman, Liv; Weber, Damien Charles; Neve, W.C. De

doi:10.1038/s41598-019-41283-1

Cited by 19 publications

(47 citation statements)

References 33 publications

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“…We named it the prone crawl breast couch (further called crawl couch) , because patients take a position resembling a phase of prone crawl swimming 19 . Dosimetric studies show reduced OAR doses with the crawl couch over supine setup in WBI + RNI 20 , 21 . However, there are no data available on set-up precision and comfort of the crawl couch.…”

Section: Introductionmentioning

confidence: 97%

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Crawl positioning improves set-up precision and patient comfort in prone whole breast irradiation

Deseyne

Speleers

Neve

et al. 2020

Sci Rep

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Prone positioning for whole-breast irradiation (WBI) reduces dose to organs at risk, but reduces set-up speed, precision, and comfort. We aimed to improve these problems by placing patients in prone crawl position on a newly developed crawl couch (CrC). A group of 10 right-sided breast cancer patients requiring WBI were randomized in this cross-over trial, comparing the CrC to a standard prone breastboard (BB). Laterolateral (LL), craniocaudal (CC) and anterioposterior (AP) set-up errors were evaluated with cone beam CT. Comfort, preference and set-up time (SUT) were assessed. Forty left and right-sided breast cancer patients served as a validation group. For BB versus CrC, AP, LL and CC mean patient shifts were − 0.8 ± 2.8, 0.2 ± 11.7 and − 0.6 ± 4.4 versus − 0.2 ± 3.3, − 0.8 ± 2.5 and − 1.9 ± 5.7 mm. LL shift spread was reduced significantly. Nine out of 10 patients preferred the CrC. SUT did not differ significantly. The validation group had mean patient shifts of 1.7 ± 2.9 (AP), 0.2 ± 3.6 (LL) and − 0.2 ± 3.3 (CC) mm. Mean SUT in the validation group was 1 min longer (P < 0.05) than the comparative group. Median SUT was 3 min in all groups. The CrC improved precision and comfort compared to BB. Set-up errors compare favourably to other prone-WBI trials and rival supine positioning.

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Section: Introductionmentioning

confidence: 97%

“…prone crawl swimming 19 . Dosimetric studies show reduced OAR doses with the crawl couch over supine setup in WBI + RNI 20,21 . However, there are no data available on set-up precision and comfort of the crawl couch.…”

mentioning

confidence: 98%

Crawl positioning improves set-up precision and patient comfort in prone whole breast irradiation

Deseyne

Speleers

Neve

et al. 2020

Sci Rep

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“…Target and OARs delineation and margin generation were performed on a Pinnacle 9.8 treatment planning system (Philips Healthcare, Fitchburg, Wisconsin, USA) as described previously 12 . In brief, the whole breast was delineated up to 5 mm from the skin surface as CTV_WBI.…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

“…However, patient support devices for prone radiotherapy share several drawbacks for locoregional radiotherapy 13 . To address these problems, we have studied a novel 'front crawl' prone position for patients requiring locoregional treatment at Ghent University [11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Comparison Between Deep Inspiration Breath Hold and Shallow Breathing for Prone Photon or Proton Irradiation of the Breast and Regional Lymph Nodes

Speleers

Schoepen

Belosi

et al. 2020

Preprint

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We report on a comparative dosimetrical study between deep inspiration breath hold (DIBH) and shallow breathing (SB) in prone crawl position for photon and proton radiotherapy of whole breast (WB) and locoregional lymph node regions, including the internal mammary chain (LN_IM). We investigate the dosimetrical effects of DIBH in prone crawl position on organs-at-risk for both photon and proton plans. For each modality, we further estimate the effects of lung and heart doses on the mortality risks of different risk profiles of patients. Thirty-one patients with invasive carcinoma of the left breast and pathologically confirmed positive lymph node status were included in this study. DIBH significantly decreased dose to heart for photon and proton radiotherapy. DIBH also decreased lung doses for photons, while increased lung doses were observed using protons because the retracting heart is displaced by low-density lung tissue. For other organs-at-risk, DIBH resulted in significant dose reductions using photons while minor differences in dose deposition between DIBH and SB were observed using protons. In high-risk patients for cardiac and lung cancer mortality, average thirty-year mortality rates from radiotherapy-related cardiac injury and lung cancer were estimated at 3.12% (photon DIBH), 4.03% (photon SB), 1.80% (proton DIBH) and 1.66% (proton SB). The radiation-related mortality risk could not outweigh the ~8% disease-specific survival benefit of WB + LN_IM radiotherapy in any of the assessed treatments. Trial registration: No trial registration was performed because there were no therapeutic interventions.

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“…Radiation oncologists implement several methods to decrease IR dose to the heart for minimizing the risk of RACVD (76), such as prone positioning (77), heart block with electronic compensation (57), heart-sparing three-dimensional printing technique (78), continuous positive airway pressure (CPAP) (79), real-time position management (RPM) inspiration gating (80,81), proton-beam irradiation (82)(83)(84)(85), and deep-inspiration breath-hold technique (DIBH) (86)(87)(88)(89)(90). However, even with the highly recommended visual-guided DIBH technique, residual variations of the heart position are still noticeable (91).…”

Section: Clinical Challenges Of Decreasing the Risk Of Racvd In Modermentioning

confidence: 99%

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

Lee

Liu

Hung

et al. 2020

Front. Cardiovasc. Med.

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Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials.

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Comparison of supine or prone crawl photon or proton breast and regional lymph node radiation therapy including the internal mammary chain

Cited by 19 publications

References 33 publications

Crawl positioning improves set-up precision and patient comfort in prone whole breast irradiation

Crawl positioning improves set-up precision and patient comfort in prone whole breast irradiation

Comparison Between Deep Inspiration Breath Hold and Shallow Breathing for Prone Photon or Proton Irradiation of the Breast and Regional Lymph Nodes

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

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