Cancer Res Treat.  2019 Oct;51(4):1370-1379. 10.4143/crt.2018.423.

Korean First Prospective Phase II Study, Feasibility of Prone Position in Postoperative Whole Breast Radiotherapy: A Dosimetric Comparison

• Chung Y
• Yu JI
• Park W
• Choi DH

• KMID: 2460586
• DOI: http://doi.org/10.4143/crt.2018.423

Abstract

PURPOSE
This first Korean prospective study is to evaluate the feasibility of prone breast radiotherapy after breast conserving surgery for left breast cancer patients who have relatively small breast size and we present dosimetric comparison between prone and supine positions.
MATERIALS AND METHODS
Fifty patients underwent two computed tomography (CT) simulations in supine and prone positions. Whole breast, ipsilateral lung, heart, and left-anterior-descending coronary artery were contoured on each simulation CT images. Tangential-fields treatment plan in each position was designed with total 50 Gy in 2-Gy fractions, and then one of the positions was designated for the treatment by comparing target coverage and dose to normal organs. Also, interfractional and intrafractional motion was evaluated using portal images.
RESULTS
In total 50 patients, 32 cases were decided as prone-position-beneficial group and 18 cases as supine-position-beneficial group based on dosimetric advantage. Target dose homogeneity was comparable, but target conformity in prone position was closer to optimal than in supine position. For both group, prone position significantly increased lung volume. However, heart volumewas decreased by prone position for prone-position-beneficial group but was comparable between two positions for supine-position-beneficial group. Lung and heart doses were significantly decreased by prone position for prone-position-beneficial group. However, prone position for supine-position-beneficial group increased heart dose while decreasing lung dose. Prone position showed larger interfractional motion but smaller intra-fractional motion than supine position.
CONCLUSION
Prone breast radiotherapy could be beneficial to a subset of small breast patients since it substantially spared normal organs while achieving adequate target coverage.

Keyword

Clinical trial; Left-sided breast neoplasms; Radiotherapy; Prone position

MeSH Terms

Breast Neoplasms
Breast*
Coronary Vessels
Feasibility Studies*
Heart
Humans
Lung
Mastectomy, Segmental
Prone Position*
Prospective Studies*
Radiotherapy*
Supine Position
Unilateral Breast Neoplasms

Figure

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  Fig. 1. Prone breast board.

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  Fig. 2. Dosimetric comparison of organs at risk between supine and prone positioning with isodose lines and dose volume histogram for a case with chest size of 84 cm and breast volume in prone position of 302 mL (A) and a case with chest size of 68 cm and breast volume in prone position of 462 mL (B). The lung (blue), heart (red), and left anterior descending coronary artery (LADCA, green) are delineated as organs at risk. CTV, clinical target volume.

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  Fig. 3. Comparison of inter- (A) and intra-fractional (B) motion between patients treated in supine and prone positions. AntPost, anterior-posterior; Sup-Inf, superior-inferior.

Reference

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