The 2-Year Cosmetic Outcome of a Randomized Trial Comparing Prone and Supine Whole-Breast Irradiation in Large-Breasted Women

Veldeman, Liv; Schiettecatte, Kimberly; Sutter, Charlotte De; Monten, Christel; Greveling, Annick Van; Berkovic, P.; Mulliez, Thomas; Neve, Wilfried De

doi:10.1016/j.ijrobp.2016.03.003

Cited by 24 publications

(27 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prone WBI has led to improved dose homogeneity and reduced skin toxicity, while reducing the dose to the lung and heart [8, 10–13, 22, 29–31]. Due to a change in breast shape, path lengths are reduced and skin folds disappear, resulting in lower acute and late toxicity [22, 31].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2017

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Due to a change in breast shape, path lengths are reduced and skin folds disappear, resulting in lower acute and late toxicity [22, 31]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…A review of the advantages, disadvantages, challenges, limitations of prone position for breast irradiation has been published by the investigators at New York University . Prone radiotherapy is advantageous for the vast majority of patients requiring breast irradiation irrespective of breast size: lower dose to lung and heart, less acute toxicity, and better cosmesis . Challenges of prone radiotherapy are numerous and centers that wish acquiring prone breast radiotherapy face a substantial learning effort.…”

Section: Discussionmentioning

confidence: 99%

“…Radiotherapy after breast‐conserving surgery improves loco‐regional control and survival at the expense of acute and late toxicity to the treated region, radiation‐induced cardiac events, lung cancer, and cancer in the nontreated breast . Prone radiotherapy allows decreasing acute toxicity, cosmetic changes, risks of radiation‐induced lung cancer, and cardiac toxicity . However, several drawbacks of prone position are reported, including reduced set‐up precision and discomfort …”

Section: Introductionmentioning

confidence: 99%

Potential benefits of crawl position for prone radiation therapy in breast cancer

Boute

Neve

Speleers

et al. 2017

J Applied Clin Med Phys

Self Cite

View full text Add to dashboard Cite

PurposeTo investigate crawl position with the arm at the treated side alongside the body and at the opposite side above the head for prone treatment in patients requiring breast and regional lymph node irradiation.MethodsPatient support devices for crawl position were built for CT simulation and treatment. An asymmetric fork design resulted from an iterative process of prototype construction and testing. The fork's large horn supports the hemi‐thorax, shoulder, and elevated arm at the nontreated side and the head. The short, narrow horn supports the arm at the treated side. Between both horns, the treated breast and its regional lymph nodes are exposed. Endpoints were pain, comfort, set‐up precision, beam access to the breast and lymph nodes, and plan dose metrics. Pain and comfort were tested by volunteers (n = 9); set‐up precision, beam access, and plan dose metrics were tested by means of a patient study (n = 10). The AIO™ (Orfit, Wijnegem, Belgium) prone breastboard (AIO™) was used as a reference regarding comfort and set‐up precision.ResultsPain at the sternum, the ipsilateral shoulder, upper arm, and neck was lower in crawl position than with bilateral arm elevation on AIO™. Comfort and set‐up precision were better on the crawl prototype than on AIO™. In crawl position, beam directions in the coronal and near‐sagittal planes have access to the breast or regional lymph nodes without traversing device components. Plan comparison between supine and crawl positions showed better dose homogeneity for the breast and lymph node targets and dose reductions to all organs at risk for crawl position.ConclusionsRadiation therapy for breast and regional lymph nodes in crawl position is feasible. Good comfort and set‐up precision were demonstrated. Planning results support the hypothesis that breast and regional lymph nodes can be treated in crawl position with less dose to organs at risk and equal or better dose distribution in the target volumes than in supine position. The crawl technique is a candidate methodology for further investigation for patients requiring breast and regional lymph node irradiation.

show abstract

“…Prone positioning is becoming more widely available with nearly one-third of centers polled having this technology in their armamentarium in a recent survey 17 . Furthermore, the number of centers adopting this technique will likely increase with recent publication of randomized data demonstrating improved cosmesis in large-breasted women treated in the prone compared with the supine position 18 . Although there is some controversy regarding the benefit of prone technique to decrease coronary artery dose, 19 we routinely treat the majority of women at our institution prone because of the demonstrable benefit in both cardiac volume exposed to radiation 15 and LAD dose 20 .…”

Section: Discussionmentioning

confidence: 99%

Preplanning prediction of the left anterior descending artery maximum dose based on patient, dosimetric, and treatment planning parameters

Cooper

Shin

et al. 2016

Advances in Radiation Oncology

View full text Add to dashboard Cite

PurposeMaximum dose to the left anterior descending artery (LADmax) is an important physical constraint to reduce the risk of cardiovascular toxicity. We generated a simple algorithm to guide the positioning of the tangent fields to reliably maintain LADmax <10 Gy.Methods and materialsDosimetric plans from 146 consecutive women treated prone to the left breast enrolled in prospective protocols of accelerated whole breast radiation therapy, with a concomitant daily boost to the tumor bed (40.5 Gy/15 fraction to the whole breast and 48 Gy to the tumor bed), provided the training set for algorithm development. Scatter plots and correlation coefficients were used to describe the bivariate relationships between LADmax and several parameters: distance from the tumor cavity to the tangent field edge, cavity size, breast separation, field size, and distance from the tangent field. A logistic sigmoid curve was used to model the relationship of LADmax and the distance from the tangent field. Furthermore, we tested this prediction model on a validation data set of 53 consecutive similar patients.ResultsA lack of linear relationships between LADmax and distance from cavity to LAD (−0.47), cavity size (−0.18), breast separation (−0.02), or field size (−0.28) was observed. In contrast, distance from the tangent field was highly negatively correlated to LADmax (-0.84) and was used in the models to predict LADmax. From a logistic sigmoid model we selected a cut-point of 2.46 mm (95% confidence interval, 2.19-2.74 mm) greater than which LADmax is <10 Gy (95% confidence interval, 9.30-10.72 Gy) and LADmean is <3.3 Gy.ConclusionsPlacing the edge of the tangents at least 2.5 mm from the closest point of the contoured LAD is likely to assure LADmax is <10 Gy and LADmean is <3.3 Gy in patients treated with prone accelerated breast radiation therapy.

show abstract

The 2-Year Cosmetic Outcome of a Randomized Trial Comparing Prone and Supine Whole-Breast Irradiation in Large-Breasted Women

Cited by 24 publications

References 28 publications

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

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

Potential benefits of crawl position for prone radiation therapy in breast cancer

Preplanning prediction of the left anterior descending artery maximum dose based on patient, dosimetric, and treatment planning parameters

Contact Info

Product

Resources

About