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

• Published in: Cancer research and treatment Vol. 51; no. 4; pp. 1370 - 1379
• Main Authors: Chung, Yoonsun, Yu, Jeong Il, Park, Won, Choi, Doo Ho
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Cancer Association 01.10.2019; 대한암학회
• Subjects: Adult; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Computer Simulation; Feasibility Studies; Female; Humans; Mastectomy, Segmental; Middle Aged; Original; Patient Positioning - instrumentation; Prospective Studies; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Republic of Korea; Tomography, X-Ray Computed - methods; 의약학; Republic of Korea; Prone position; Clinical trial; Left-sided breast neoplasms; Radiotherapy
• ISSN: 1598-2998; 2005-9256
• DOI: 10.4143/crt.2018.423

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. 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. 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. Prone breast radiotherapy could be beneficial to a subset of small breast patients since it substantially spared normal organs while achieving adequate target coverage.