@article{01H8HT42Y57NC8CEKJYQ5G5BH9,
  abstract     = {{ObjectiveMost patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcomes, photographic assessment, and dosimetry between both positions using REQUITE data.MethodsREQUITE is an international multi-centre prospective observational study that recruited 2069 breast cancer patients receiving radiotherapy. Data on toxicity, health-related quality of life (HRQoL), and dosimetry were collected, as well as a photographic assessment. A matched case control analysis compared patients treated prone (n = 268) versus supine (n = 493). Exact matching was performed for the use of intensity-modulated radiotherapy, boost, lymph node irradiation, chemotherapy and fractionation, and the nearest neighbour for breast volume. Primary endpoints were dermatitis at the end of radiotherapy, and atrophy and cosmetic outcome by photographic assessment at two years.ResultsAt the last treatment fraction, there was no significant difference in dermatitis (p = .28) or any HRQoL domain, but prone positioning increased the risk of breast oedema (p < .001). At 2 years, patients treated in prone position had less atrophy (p = .01), and higher body image (p < .001), and social functioning (p < .001) scores. The photographic assessment showed no difference in cosmesis at 2 years (p = .22). In prone position, mean heart dose (MHD) was significantly lower for left-sided patients (1.29 Gy vs 2.10 Gy, p < .001) and ipsilateral mean lung dose (MLD) was significantly lower for all patients (2.77 Gy vs 5.89 Gy, p < .001).ConclusionsProne radiotherapy showed lower MLD and MHD compared to supine position, although the risk of developing breast oedema during radiotherapy was higher. At 2 years the photographic assessment showed no difference in the cosmetic outcome, but less atrophy was seen in prone-treated patients and this seems to have a positive influence on the HRQoL domain of body image.}},
  author       = {{Vakaet, Vincent and Deseyne, Pieter and Bultijnck, Renée and Post, Giselle and West, Catharine and Azria, David and Bourgier, Celine and Farcy-Jacquet, Marie-Pierre and Rosenstein, Barry and Green, Sheryl and de Ruysscher, Dirk and Sperk, Elena and Veldwijk, Marlon and Herskind, Carsten and De Santis, Maria Carmen and Rancati, Tiziana and Giandini, Tommaso and Chang-Claude, Jenny and Seibold, Petra and Lambrecht, Maarten and Weltens, Caroline and Janssens, Hilde and Vega, Ana and Taboada-Valladares, Maria Begoña and Aguado-Barrera, Miguel Elías and Reyes, Victoria and Altabas, Manuel and Gutiérrez-Enríquez, Sara and Monten, Christel and Van Hulle, Hans and Veldeman, Liv}},
  issn         = {{0284-186X}},
  journal      = {{ACTA ONCOLOGICA}},
  keywords     = {{Radiology, Nuclear Medicine and imaging,Oncology,Hematology,General Medicine,dosimetry,health-related quality of life,radiotherapy toxicity,prone position,Breast cancer,QUALITY-OF-LIFE,MODULATED RADIATION-THERAPY,RANDOMIZED-TRIAL,EUROPEAN-ORGANIZATION,HEART-DISEASE,WHOLE,IRRADIATION,TOXICITY,LUNG,EXPOSURE}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{1036--1044}},
  title        = {{Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data : dosimetry, acute and two years physician and patient-reported outcomes}},
  url          = {{http://doi.org/10.1080/0284186x.2023.2240486}},
  volume       = {{62}},
  year         = {{2023}},
}

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