The prone technique for breast irradiation – is it ready for clinical trials?

McKinnon, R.; Christie, David; Peres, Helen; Burke, Marie; Le, Thai‐Ha; Lah, Minjae

doi:10.1016/j.breast.2008.09.006

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…21/25 (84%) patients satisfactorily completed 173/192 (90%) planned prone RT fractions. This is fewer than reported in previous feasibility studies of the prone position (3)(4)(5)(6)(7)(8)(9). This may have been because our protocol specified tolerance criteria for set-up errors beyond which women were required to complete treatment in a supine position.…”

Section: Discussionmentioning

confidence: 77%

“…Data suggest that prone treatment is feasible (3)(4)(5)(6)(7)(8)(9), but results of studies using electronic-portal imaging (EPI) to investigate inter-fractional variations in breast-tissue position during prone treatment are conflicting (8,9). Morrow et al (9) reported individual-patient systematic errors of 0.1-16.5mm with a pooled random error of 5.4mm and calculated, using the van Herk formula (10), a CTV-PTV margin of 20mm for prone PBI.…”

Section: Introductionmentioning

confidence: 99%

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A randomised trial of Supine versus Prone breast radiotherapy (SuPr study): Comparing set-up errors and respiratory motion

Kirby

Evans

Helyer

et al. 2011

Radiotherapy and Oncology

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

A randomised trial of Supine versus Prone breast radiotherapy (SuPr study): Comparing set-up errors and respiratory motion

Kirby

Evans

Helyer

et al. 2011

Radiotherapy and Oncology

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“…The purpose of this study was to evaluate the feasibility of using 64‐slice spiral CTA to help delineate the substructures of the heart in patients that underwent left breast‐conserving surgery, and to compare the dosimetric difference between IMRT plans in the prone and supine positions. In most studies, the LAD was contoured based on the anatomy instead of based on an image of the virtual structure, (19,16) which may have caused increased intra‐observer bias. The LAD can also be observed during PET scanning.…”

Section: Discussionmentioning

confidence: 99%

“…By pulling the breast away from the chest wall, this position can reduce the dose to the lung, heart, and contralateral breast. The breast becomes longer and narrower, which provides better dose distribution and uniformity (9,11,15‐18) …”

Section: Introductionmentioning

confidence: 99%

A dosimetry study precisely outlining the heart substructure of left breast cancer patients using intensity‐modulated radiation therapy

Fan

Luo

et al. 2014

J Applied Clin Med Phys

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The purpose of this study was to evaluate the feasibility of delineating the substructure of the heart by using 64‐slice spiral CT coronary angiography (CTA) in breast cancer patients who underwent left breast‐conserving surgery, and to compare the dosimetric differences between the targets and organs at risk in the prone and supine positions in intensity‐modulated radiation therapy (IMRT) planning. From January to December 2011, ten patients who underwent left breast‐conserving surgery were enrolled in this study. CTA was performed in both the supine and prone positions during the simulation, and conventional scanning without CTA was performed at the same time. Image registration was performed for paired image series using a commercially available planning system. In a conventional image series, the clinical target volume (CTV) of the whole breast, planning target volume (PTV), bilateral lungs (L‐Lung, R‐Lung), spinal cord, contralateral breast (R‐Breast), and heart were delineated. In the CTA image series, the left ventricular (LV) and left anterior descending coronary arteries (LAD) and the planning risk volume (LAD‐PRV) of the LAD (LAD with a 1 cm margin) were outlined. For each patient, two separate IMRT plans were developed for the supine and prone positions. A total of 20 plans were generated. The following indicators were compared: Dmean and D95 for the PTV; Dmean, V5, and V20 for the left lung; Dmean, V10, V20, V25, V30, and V40 for the heart and its substructures (LAD‐PRV, LV); Dmean and V5 for the right lung; and Dmax and Dmean for the right breast. Using CTA to delineate the substructures of the heart is simple and straightforward. Plans for both the prone and supine positions reached the prescribed dose for the PTV without significant differences. Dose distributions were acceptable for both the prone and supine positions. However, the LAD‐PRV, LV, heart, and L‐Lung received smaller doses in the prone position plans than in the supine position plans. The Dmean values reduced by 445.83thinmathspacecGy(p=0.043),575.00thinmathspacecGy(p=0.003),402.00thinmathspacecGy(p=0.039), and 553.33thinmathspacecGy(p=0.004) in the LAD‐PRV, LV, heart, and L‐Lung. In addition, the V25 lessened 12.54%(p=0.042) and 8.70%(p=0.019) in the LV and heart, while the V20 was decreased 8.57%(p=0.042),15.21%(p=0.026),12.59%(p=0.011), and 10.62%(p=0.006) in the LAD‐PRV, LV, heart, and L‐Lung, respectively. Similarly, the V10 and V30 were reduced by 28.31% (p=0.029) and 5.54%(p=0.034) in the heart, while the V5 was cut back 27.86%(p=0.031) in the L‐Lung. For most Asian women with average‐sized breasts after breast conserving treatment (BCT), prone positioning during IMRT radiation will reduce the dose to the ipsilateral lung, heart, and substructures of the heart, which may reduce the incidence of cardiovascular events after radiotherapy more than radiation therapy performed in a supine position. Using CTA to delineate the substructures of the heart is easy and intuitive. It is cost‐effective and highly recommended for breast cance...

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“…The patient's arm is usually extended overhead to expose the axilla during EBRT. Positioning the patient in a supine position is the common method for treatment, but the current trend is prone position delivery [5][6][7]. Popular immobilization devices include thermoplastics, the Kuske breast applicator (Fig.…”

Section: Background and Clinical Significancementioning

confidence: 99%

Immobilization and catheter guidance for breast brachytherapy

et al. 2011

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The prone technique for breast irradiation – is it ready for clinical trials?

Abstract: This study shows that prone breast irradiation for patients with large or pendulous breasts can be readily developed in radiotherapy treatment centers and could be tested for efficacy in a large, multi-centre randomized trial.

Cited by 8 publications

References 17 publications

A randomised trial of Supine versus Prone breast radiotherapy (SuPr study): Comparing set-up errors and respiratory motion

A randomised trial of Supine versus Prone breast radiotherapy (SuPr study): Comparing set-up errors and respiratory motion

A dosimetry study precisely outlining the heart substructure of left breast cancer patients using intensity‐modulated radiation therapy

Immobilization and catheter guidance for breast brachytherapy

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