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Prone breast and lymph node irradiation in 5 or 15 fractions : a randomized 2 x 2 design comparing dosimetry, acute toxicity, and set-up errors

Vincent Vakaet (UGent) , Pieter Deseyne, Max Schoepen (UGent) , Michael Stouthandel (UGent) , Giselle Post (UGent) , Bruno Speleers (UGent) , Annick Van Greveling (UGent) , Christel Monten (UGent) , Marcus Mareel (UGent) , Hans Van Hulle, et al.
(2022) PRACTICAL RADIATION ONCOLOGY. 12(4). p.324-334
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Abstract
Purpose: Prone whole breast irradiation results in lower dose to organs at risk compared with supine position, especially lung dose. However, the adoption of prone position for whole breast irradiation + lymph node irradiation remains limited and data on lymph node irradiation in 5 fractions are lacking. Although the study was ended prematurely for the primary endpoint (breast retraction at 2 years), we decided to report acute toxicity for prone and supine positions and 5 and 15 fractions. Additionally, dosimetry and set-up accuracy between prone and supine positions were evaluated. Methods and Materials: A randomized open-label factorial 2 x 2 design was used for an acute toxicity comparison between prone and supine positions and 5 and 15 fractions. The primary endpoint of the trial was breast retraction 2 years after treatment. In total, 57 patients were evaluated. Dosimetry and set-up errors were compared between prone and supine positions. All patients were positioned on either our in -house developed prone crawl breast couch or a Posirest-2 (Civco). Results: No difference in acute toxicity between prone and supine positions was found, but 5 fractions did result in a lower risk of desquamation (15% vs 41%; P =.04). Prone positioning resulted in lower mean ipsilateral lung dose (2.89 vs 4.89 Gy; P <.001), mean thyroid dose (3.42 vs 6.61 Gy; P =.004), and mean contralateral breast dose (0.41 vs 0.54 Gy; P =.007). No significant difference in mean heart dose (0.90 vs 1.07 Gy; P =.22) was found. Set-up accuracy was similar between both positions. Conclusions: Unfortunately, the primary endpoint of the trial was not met due to premature closure of the trial. Acceleration in 5 fractions resulted in a lower risk of desquamation. Prone positioning did not influence acute toxicity or set-up accuracy, but did result in lower ipsilateral mean lung dose, thyroid dose, and contralateral breast dose. (C) 2022 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
Keywords
RADIATION-THERAPY, CANCER RADIOTHERAPY, HEART-DISEASE, LUNG-CANCER, WHOLE, TRIAL, WOMEN, POSITION, PATIENT, DELINEATION

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MLA
Vakaet, Vincent, et al. “Prone Breast and Lymph Node Irradiation in 5 or 15 Fractions : A Randomized 2 x 2 Design Comparing Dosimetry, Acute Toxicity, and Set-up Errors.” PRACTICAL RADIATION ONCOLOGY, vol. 12, no. 4, 2022, pp. 324–34, doi:10.1016/j.prro.2022.01.017.
APA
Vakaet, V., Deseyne, P., Schoepen, M., Stouthandel, M., Post, G., Speleers, B., … Veldeman, L. (2022). Prone breast and lymph node irradiation in 5 or 15 fractions : a randomized 2 x 2 design comparing dosimetry, acute toxicity, and set-up errors. PRACTICAL RADIATION ONCOLOGY, 12(4), 324–334. https://doi.org/10.1016/j.prro.2022.01.017
Chicago author-date
Vakaet, Vincent, Pieter Deseyne, Max Schoepen, Michael Stouthandel, Giselle Post, Bruno Speleers, Annick Van Greveling, et al. 2022. “Prone Breast and Lymph Node Irradiation in 5 or 15 Fractions : A Randomized 2 x 2 Design Comparing Dosimetry, Acute Toxicity, and Set-up Errors.” PRACTICAL RADIATION ONCOLOGY 12 (4): 324–34. https://doi.org/10.1016/j.prro.2022.01.017.
Chicago author-date (all authors)
Vakaet, Vincent, Pieter Deseyne, Max Schoepen, Michael Stouthandel, Giselle Post, Bruno Speleers, Annick Van Greveling, Christel Monten, Marcus Mareel, Hans Van Hulle, Leen Paelinck, Werner De Gersem, Wilfried De Neve, Katrien Vandecasteele, and Liv Veldeman. 2022. “Prone Breast and Lymph Node Irradiation in 5 or 15 Fractions : A Randomized 2 x 2 Design Comparing Dosimetry, Acute Toxicity, and Set-up Errors.” PRACTICAL RADIATION ONCOLOGY 12 (4): 324–334. doi:10.1016/j.prro.2022.01.017.
Vancouver
1.
Vakaet V, Deseyne P, Schoepen M, Stouthandel M, Post G, Speleers B, et al. Prone breast and lymph node irradiation in 5 or 15 fractions : a randomized 2 x 2 design comparing dosimetry, acute toxicity, and set-up errors. PRACTICAL RADIATION ONCOLOGY. 2022;12(4):324–34.
IEEE
[1]
V. Vakaet et al., “Prone breast and lymph node irradiation in 5 or 15 fractions : a randomized 2 x 2 design comparing dosimetry, acute toxicity, and set-up errors,” PRACTICAL RADIATION ONCOLOGY, vol. 12, no. 4, pp. 324–334, 2022.
@article{01HRD07GBTQJJDQ2DFK4X81K1G,
  abstract     = {{Purpose: Prone whole breast irradiation results in lower dose to organs at risk compared with supine position, especially lung dose. However, the adoption of prone position for whole breast irradiation + lymph node irradiation remains limited and data on lymph node irradiation in 5 fractions are lacking. Although the study was ended prematurely for the primary endpoint (breast retraction at 2 years), we decided to report acute toxicity for prone and supine positions and 5 and 15 fractions. Additionally, dosimetry and set-up accuracy between prone and supine positions were evaluated.

 Methods and Materials: A randomized open-label factorial 2 x 2 design was used for an acute toxicity comparison between prone and supine positions and 5 and 15 fractions. The primary endpoint of the trial was breast retraction 2 years after treatment. In total, 57 patients were evaluated. Dosimetry and set-up errors were compared between prone and supine positions. All patients were positioned on either our in -house developed prone crawl breast couch or a Posirest-2 (Civco).

 Results: No difference in acute toxicity between prone and supine positions was found, but 5 fractions did result in a lower risk of desquamation (15% vs 41%; P =.04). Prone positioning resulted in lower mean ipsilateral lung dose (2.89 vs 4.89 Gy; P <.001), mean thyroid dose (3.42 vs 6.61 Gy; P =.004), and mean contralateral breast dose (0.41 vs 0.54 Gy; P =.007). No significant difference in mean heart dose (0.90 vs 1.07 Gy; P =.22) was found. Set-up accuracy was similar between both positions.

 Conclusions: Unfortunately, the primary endpoint of the trial was not met due to premature closure of the trial. Acceleration in 5 fractions resulted in a lower risk of desquamation. Prone positioning did not influence acute toxicity or set-up accuracy, but did result in lower ipsilateral mean lung dose, thyroid dose, and contralateral breast dose. (C) 2022 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.}},
  author       = {{Vakaet, Vincent and Deseyne, Pieter and Schoepen, Max and Stouthandel, Michael and Post, Giselle and Speleers, Bruno and Van Greveling, Annick and Monten, Christel and Mareel, Marcus and Van Hulle, Hans and Paelinck, Leen and De Gersem, Werner and De Neve, Wilfried and Vandecasteele, Katrien and Veldeman, Liv}},
  issn         = {{1879-8500}},
  journal      = {{PRACTICAL RADIATION ONCOLOGY}},
  keywords     = {{RADIATION-THERAPY,CANCER RADIOTHERAPY,HEART-DISEASE,LUNG-CANCER,WHOLE,TRIAL,WOMEN,POSITION,PATIENT,DELINEATION}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{324--334}},
  title        = {{Prone breast and lymph node irradiation in 5 or 15 fractions : a randomized 2 x 2 design comparing dosimetry, acute toxicity, and set-up errors}},
  url          = {{http://doi.org/10.1016/j.prro.2022.01.017}},
  volume       = {{12}},
  year         = {{2022}},
}
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