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Comparison of supine or prone crawl photon or proton breast and regional lymph node radiation therapy including the internal mammary chain

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Abstract
We report on a dosimetrical study comparing supine (S) and prone-crawl (P) position for radiotherapy of whole breast (WB) and loco-regional lymph node regions, including the internal mammary chain (LN_IM). Six left sided breast cancer patients were CT-simulated in S and P positions and four patients only in P position. Treatment plans were made using non-coplanar volumetric modulated arc photon therapy (VMAT) or pencil beam scanning intensity modulated proton therapy (IMPT). Dose prescription was 15*2.67 Gy(GyRBE). The average mean heart doses for S or P VMAT were 5.6 or 4.3 Gy, respectively (p = 0.16) and 1.02 or 1.08 GyRBE, respectively for IMPT (p = 0.8; p < 0.001 for IMPT versus VMAT). The average mean lung doses for S or P VMAT were 5.91 or 2.90 Gy, respectively (p = 0.002) and 1.56 or 1.09 GyRBE, respectively for IMPT (p = 0.016). In high-risk patients, average (range) thirty-year mortality rates from radiotherapy-related cardiac injury and lung cancer were estimated at 6.8(5.4-9.4)% or 3.8(2.8-5.1)% for S or P VMAT (p < 0.001), respectively, and 1.6(1.1-2.0)% or 1.2(0.8-1.6)% for S or P IMPT (p = 0.25), respectively. Radiation-related mortality risk could outweigh the similar to 8% disease-specific survival benefit of WB + LN_IM radiotherapy for S VMAT but not P VMAT. IMPT carries the lowest radiation-related mortality risks.
Keywords
RANDOMIZED-TRIAL, DELINEATION GUIDELINES, CANCER RADIOTHERAPY, HEART-DISEASE, LUNG-CANCER, IRRADIATION, MORTALITY, EXPOSURE, POSITION, WOMEN

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MLA
Speleers, Bruno, et al. “Comparison of Supine or Prone Crawl Photon or Proton Breast and Regional Lymph Node Radiation Therapy Including the Internal Mammary Chain.” SCIENTIFIC REPORTS, vol. 9, 2019.
APA
Speleers, B., Belosi, F. M., De Gersem, W., Deseyne, P., Paelinck, L., Bolsi, A., … De Neve, W. (2019). Comparison of supine or prone crawl photon or proton breast and regional lymph node radiation therapy including the internal mammary chain. SCIENTIFIC REPORTS, 9.
Chicago author-date
Speleers, Bruno, Francesca M Belosi, Werner De Gersem, Pieter Deseyne, Leen Paelinck, Alessandra Bolsi, Antony J Lomax, et al. 2019. “Comparison of Supine or Prone Crawl Photon or Proton Breast and Regional Lymph Node Radiation Therapy Including the Internal Mammary Chain.” SCIENTIFIC REPORTS 9.
Chicago author-date (all authors)
Speleers, Bruno, Francesca M Belosi, Werner De Gersem, Pieter Deseyne, Leen Paelinck, Alessandra Bolsi, Antony J Lomax, Bert Boute, Annick Van Greveling, Christel Monten, Joris Van de Velde, Tom Vercauteren, Liv Veldeman, Damien C Weber, and Wilfried De Neve. 2019. “Comparison of Supine or Prone Crawl Photon or Proton Breast and Regional Lymph Node Radiation Therapy Including the Internal Mammary Chain.” SCIENTIFIC REPORTS 9.
Vancouver
1.
Speleers B, Belosi FM, De Gersem W, Deseyne P, Paelinck L, Bolsi A, et al. Comparison of supine or prone crawl photon or proton breast and regional lymph node radiation therapy including the internal mammary chain. SCIENTIFIC REPORTS. 2019;9.
IEEE
[1]
B. Speleers et al., “Comparison of supine or prone crawl photon or proton breast and regional lymph node radiation therapy including the internal mammary chain,” SCIENTIFIC REPORTS, vol. 9, 2019.
@article{8611182,
  abstract     = {We report on a dosimetrical study comparing supine (S) and prone-crawl (P) position for radiotherapy of whole breast (WB) and loco-regional lymph node regions, including the internal mammary chain (LN_IM). Six left sided breast cancer patients were CT-simulated in S and P positions and four patients only in P position. Treatment plans were made using non-coplanar volumetric modulated arc photon therapy (VMAT) or pencil beam scanning intensity modulated proton therapy (IMPT). Dose prescription was 15*2.67 Gy(GyRBE). The average mean heart doses for S or P VMAT were 5.6 or 4.3 Gy, respectively (p = 0.16) and 1.02 or 1.08 GyRBE, respectively for IMPT (p = 0.8; p < 0.001 for IMPT versus VMAT). The average mean lung doses for S or P VMAT were 5.91 or 2.90 Gy, respectively (p = 0.002) and 1.56 or 1.09 GyRBE, respectively for IMPT (p = 0.016). In high-risk patients, average (range) thirty-year mortality rates from radiotherapy-related cardiac injury and lung cancer were estimated at 6.8(5.4-9.4)% or 3.8(2.8-5.1)% for S or P VMAT (p < 0.001), respectively, and 1.6(1.1-2.0)% or 1.2(0.8-1.6)% for S or P IMPT (p = 0.25), respectively. Radiation-related mortality risk could outweigh the similar to 8% disease-specific survival benefit of WB + LN_IM radiotherapy for S VMAT but not P VMAT. IMPT carries the lowest radiation-related mortality risks.},
  articleno    = {4755},
  author       = {Speleers, Bruno and Belosi, Francesca M and De Gersem, Werner and Deseyne, Pieter and Paelinck, Leen and Bolsi, Alessandra and Lomax, Antony J and Boute, Bert and Van Greveling, Annick and Monten, Christel and Van de Velde, Joris and Vercauteren, Tom and Veldeman, Liv and Weber, Damien C and De Neve, Wilfried},
  issn         = {2045-2322},
  journal      = {SCIENTIFIC REPORTS},
  keywords     = {RANDOMIZED-TRIAL,DELINEATION GUIDELINES,CANCER RADIOTHERAPY,HEART-DISEASE,LUNG-CANCER,IRRADIATION,MORTALITY,EXPOSURE,POSITION,WOMEN},
  language     = {eng},
  pages        = {9},
  title        = {Comparison of supine or prone crawl photon or proton breast and regional lymph node radiation therapy including the internal mammary chain},
  url          = {http://dx.doi.org/10.1038/s41598-019-41283-1},
  volume       = {9},
  year         = {2019},
}

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