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

Bert Boute (UGent) , Wilfried De Neve (UGent) , Bruno Speleers (UGent) , Annick Van Greveling (UGent) , Christel Monten (UGent) , Tom Van Hoof (UGent) , Joris Van de Velde (UGent) , Leen Paelinck (UGent) , Werner De Gersem (UGent) , Tom Vercauteren (UGent) , et al.
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Abstract
Purpose: To 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. Methods: Patient 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 AIOTM (Orfit, Wijnegem, Belgium) prone breastboard (AIOTM) was used as a reference regarding comfort and set-up precision. Results: Pain at the sternum, the ipsilateral shoulder, upper arm, and neck was lower in crawl position than with bilateral arm elevation on AIOTM. Comfort and setup precision were better on the crawl prototype than on AIOTM. 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. Conclusions: Radiation 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.
Keywords
breast cancer, crawl position, prone radiotherapy, TRIAL COMPARING PRONE, HEART-DISEASE, LUNG-CANCER, IRRADIATION, RADIOTHERAPY, WOMEN, RISK

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Chicago
Boute, Bert, Wilfried De Neve, Bruno Speleers, Annick Van Greveling, Christel Monten, Tom Van Hoof, Joris Van de Velde, et al. 2017. “Potential Benefits of Crawl Position for Prone Radiation Therapy in Breast Cancer.” Journal of Applied Clinical Medical Physics 18 (4): 200–205.
APA
Boute, Bert, De Neve, W., Speleers, B., Van Greveling, A., Monten, C., Van Hoof, T., Van de Velde, J., et al. (2017). Potential benefits of crawl position for prone radiation therapy in breast cancer. JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, 18(4), 200–205.
Vancouver
1.
Boute B, De Neve W, Speleers B, Van Greveling A, Monten C, Van Hoof T, et al. Potential benefits of crawl position for prone radiation therapy in breast cancer. JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS. 2017;18(4):200–5.
MLA
Boute, Bert, Wilfried De Neve, Bruno Speleers, et al. “Potential Benefits of Crawl Position for Prone Radiation Therapy in Breast Cancer.” JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS 18.4 (2017): 200–205. Print.
@article{8520355,
  abstract     = {Purpose: To 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. 
Methods: Patient 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 AIOTM (Orfit, Wijnegem, Belgium) prone breastboard (AIOTM) was used as a reference regarding comfort and set-up precision. 
Results: Pain at the sternum, the ipsilateral shoulder, upper arm, and neck was lower in crawl position than with bilateral arm elevation on AIOTM. Comfort and setup precision were better on the crawl prototype than on AIOTM. 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. 
Conclusions: Radiation 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.},
  author       = {Boute, Bert and De Neve, Wilfried and Speleers, Bruno and Van Greveling, Annick and Monten, Christel and Van Hoof, Tom and Van de Velde, Joris and Paelinck, Leen and De Gersem, Werner and Vercauteren, Tom and Detand, Jan and Veldeman, Liv},
  issn         = {1526-9914},
  journal      = {JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS},
  language     = {eng},
  number       = {4},
  pages        = {200--205},
  title        = {Potential benefits of crawl position for prone radiation therapy in breast cancer},
  url          = {http://dx.doi.org/10.1002/acm2.12118},
  volume       = {18},
  year         = {2017},
}

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