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

Pieter Deseyne UGent, Bruno Speleers UGent, Wilfried De Neve UGent, Bert Boute UGent, LEEN PAELINCK, Tom Van Hoof UGent, Joris Van de Velde UGent, ANNICK VAN GREVELING, Christel Monten UGent, Giselle Post UGent, et al. (2017) RADIATION ONCOLOGY. 12.
abstract
Background: Prone 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). Methods: A 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. Results: Target 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. Conclusions: Prone 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.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
Adjuvant radiotherapy, Breast irradiation, Regional nodal irradiation, Breast cancer, Prone position, Prone crawl position, Dosimetry, Organs at risk, VMAT, INTENSITY-MODULATED RADIOTHERAPY, ELECTIVE RADIATION-THERAPY, ESTRO CONSENSUS GUIDELINE, TARGET VOLUME DELINEATION, POPULATION-BASED COHORT, TRIAL COMPARING PRONE, AXILLARY LYMPH-NODES, CONTRALATERAL BREAST, INTERNAL MAMMARY, LUNG-CANCER
journal title
RADIATION ONCOLOGY
Radiat. Oncol.
volume
12
article number
89
pages
12 pages
Web of Science type
Article
Web of Science id
000402198400001
ISSN
1748-717X
DOI
10.1186/s13014-017-0828-6
language
English
UGent publication?
yes
classification
A1
copyright statement
Creative Commons Attribution 4.0 International Public License (CC-BY 4.0)
id
8521464
handle
http://hdl.handle.net/1854/LU-8521464
date created
2017-05-29 11:24:09
date last changed
2017-07-14 07:02:08
@article{8521464,
  abstract     = {Background: Prone 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). 
Methods: A 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. 
Results: Target volume coverage differed only slightly between prone and supine position. Doses were significantly reduced (P {\textlangle} 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. 
Conclusions: Prone 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.},
  articleno    = {89},
  author       = {Deseyne, Pieter and Speleers, Bruno and De Neve, Wilfried and Boute, Bert and PAELINCK, LEEN and Van Hoof, Tom and Van de Velde, Joris and VAN GREVELING, ANNICK and Monten, Christel and Post, Giselle and Depypere, Herman and Veldeman, Liv},
  issn         = {1748-717X},
  journal      = {RADIATION ONCOLOGY},
  keyword      = {Adjuvant radiotherapy,Breast irradiation,Regional nodal irradiation,Breast cancer,Prone position,Prone crawl position,Dosimetry,Organs at risk,VMAT,INTENSITY-MODULATED RADIOTHERAPY,ELECTIVE RADIATION-THERAPY,ESTRO CONSENSUS GUIDELINE,TARGET VOLUME DELINEATION,POPULATION-BASED COHORT,TRIAL COMPARING PRONE,AXILLARY LYMPH-NODES,CONTRALATERAL BREAST,INTERNAL MAMMARY,LUNG-CANCER},
  language     = {eng},
  pages        = {12},
  title        = {Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer},
  url          = {http://dx.doi.org/10.1186/s13014-017-0828-6},
  volume       = {12},
  year         = {2017},
}

Chicago
Deseyne, Pieter, Bruno Speleers, Wilfried De Neve, Bert Boute, LEEN PAELINCK, Tom Van Hoof, Joris Van de Velde, et al. 2017. “Whole Breast and Regional Nodal Irradiation in Prone Versus Supine Position in Left Sided Breast Cancer.” Radiation Oncology 12.
APA
Deseyne, P., Speleers, B., De Neve, W., Boute, B., PAELINCK, L., Van Hoof, T., Van de Velde, J., et al. (2017). Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer. RADIATION ONCOLOGY, 12.
Vancouver
1.
Deseyne P, Speleers B, De Neve W, Boute B, PAELINCK L, Van Hoof T, et al. Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer. RADIATION ONCOLOGY. 2017;12.
MLA
Deseyne, Pieter, Bruno Speleers, Wilfried De Neve, et al. “Whole Breast and Regional Nodal Irradiation in Prone Versus Supine Position in Left Sided Breast Cancer.” RADIATION ONCOLOGY 12 (2017): n. pag. Print.