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

Pieter Deseyne, Bruno Speleers, Wilfried De Neve, Bert Boute, Leen Paelinck, Tom Van Hoof, Joris Van de Velde, Annick Van Greveling, Chris Monten, Giselle Post, Herman Depypere, Liv Veldeman, Pieter Deseyne, Bruno Speleers, Wilfried De Neve, Bert Boute, Leen Paelinck, Tom Van Hoof, Joris Van de Velde, Annick Van Greveling, Chris Monten, Giselle Post, Herman Depypere, Liv Veldeman

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.

Trial registration: No trial registration was performed because there were no therapeutic interventions.

Keywords: Adjuvant radiotherapy; Breast cancer; Breast irradiation; Dosimetry; Organs at risk; Prone crawl position; Prone position; Regional nodal irradiation; VMAT.

Figures

Fig. 1
Fig. 1
Patient setup on a prototype of the crawl breast couch. a The ipsilateral arm is positioned on a support along the waist. The head is turned away from the ispilateral side towards the contralateral arm, which is extended along the head. b Red floor laser beam projected on the breast
Fig. 2
Fig. 2
Illustration of the coplanar multiple overlying partial arc VMAT technique. The yellow lines indicate beam apertures of the different used beam angles, avoiding OAR such as the heart, lung and the ipsilateral arm
Fig. 3
Fig. 3
Individual DVH’s for each patient in WB + LNI to the whole axilla
Fig. 4
Fig. 4
Individual DVH’s for each patient in WB + LNI to the partial axilla

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