Prog Med Phys.  2023 Mar;34(1):10-13. 10.14316/pmp.2023.34.1.10.

Clinical Impact of Patient’s Head Position in Supraclavicular Irradiation of the Whole Breast Radiotherapy

• Anbumani S
• Reddy LG
• V P
• P S
• Bilimagga RS

• KMID: 2541142
• DOI: http://doi.org/10.14316/pmp.2023.34.1.10

Abstract

Patients with breast cancer can be positioned with their head turned to the contra lateral side or with their head straight during the radiation therapy treatment set-up. In our hospital, patients with locally advanced breast cancer who were receiving radiation therapy have experienced swallowing difficulty after 2 weeks of irradiation. In this pilot study, the impact of head position on reducing dysphagia occurrence was dosimetrically evaluated. Patients were divided into two groups viz., HT (head turned to the contra lateral side of the breast) and HS (head straight) with 10 members in each. Treatment planning was performed, and the dosimetric parameters such as Dmin, Dmax, Dmean, V₅, V₁₀, V₂₀, V₃₀, V₄₀, and V₅₀ of both groups were extracted from the dose volume histogram (DVH) of esophagus. The target coverage in the supraclavicular fossa (SCF) region was analyzed using D₉₅ and D₉₈; moreover, the dose heterogeneity was assessed with D₂ from the DVHs. The average values of the dose volume parameters were 27.6%, 58.6%, 35.4%, 19%, 13.8%, 14.1%, 11.8%, 8.4%, and 8.1% higher in the HT group compared with those in the HS group. Furthermore, for the SCF, the mean values of D₉₈, D₉₅, and D₂ were 42.4, 47.5, and 54 Gy, respectively, in the HS group and 38.9, 45.35, and 55.5 Gy, respectively, in the HT group. This pilot study attempts to give a solution for the poor quality of life of patients after breast radiotherapy due to dysphagia. The findings confirm that the head position could play a significant role in alleviating esophageal toxicity without compromising tumor control.

Keyword

Head position; Breast radiotherapy; Supraclavicular fossa irradiation; Dose volume histogram; Esophageal dysphagia