Prone versus supine positioning for whole and partial breast radiotherapy: a comparison of non-target tissue dosimetry

Kirby, A.M., Evans, P.M., Donovan, E.M., Convery, H.M., Haviland, J.S. and Yarnold, J.S. (2010) Prone versus supine positioning for whole and partial breast radiotherapy: a comparison of non-target tissue dosimetry. Radiotherapy and Oncology, 96 (2), 178-184. (doi:10.1016/j.radonc.2010.05.014).

Abstract

Purpose: to compare non-target tissue (including left-anterior-descending coronary-artery (LAD)) dosimetry of prone versus supine whole (WBI) and partial-breast irradiation (PBI).

Methods and materials: sixty-five post-lumpectomy breast cancer patients underwent CT-imaging supine and prone. On each dataset, the whole-breast clinical-target-volume (WB-CTV), partial-breast CTV (tumour-bed + 15 mm), ipsilateral-lung and chest-wall were outlined. Heart and LAD were outlined in left-sided cases (n = 30). Tangential-field WBI and PBI plans were generated for each position. Mean LAD, heart, and ipsilateral-lung doses (xmean), maximum LAD (LADmax) doses, and the volume of chest-wall receiving 50 Gy (V50Gy) were compared.

Results: two-hundred and sixty plans were generated. Prone positioning reduced heart and LAD doses in 19/30 WBI cases (median reduction in LADmean = 6.2 Gy) and 7/30 PBI cases (median reduction in LADmax = 29.3 Gy) (no difference in 4/30 cases). However, prone positioning increased cardiac doses in 8/30 WBI (median increase in LADmean = 9.5 Gy) and 19/30 PBI cases (median increase in LADmax = 22.9 Gy) (no difference in 3/30 cases). WB-CTV > 1000cm3 was associated with improved cardiac dosimetry in the prone position for WBI (p = 0.04) and PBI (p = 0.04). Prone positioning reduced ipsilateral-lungmean in 65/65 WBI and 61/65 PBI cases, and chest-wall V50Gy in all WBI cases. PBI reduced normal-tissue doses compared to WBI in all cases, regardless of the treatment position.

Conclusions: in the context of tangential-field WBI and PBI, prone positioning is likely to benefit left-breast-affected women of larger breast volume, but to be detrimental in left-breast-affected women of smaller breast volume. Right-breast-affected women are likely to benefit from prone positioning regardless of breast volume

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