Antonette Grandison

The Effect of e Prone Versus Supine Position in Whole Breast Radiation in Relation to

Reduction in Dose to Organs at Risk

Introduction

Whole breast radiation therapy (WBI) is a common standard of care as a treatment for

breast cancer and is often used in conjunction with surgery. Although WBI has been found to

reduce local recurrence rates, other complications often result as latent effects from radiation

(Verhoeven et al, 2). The complications most often suffered by patients include cardiac and

pulmonary toxicity with an increase chance of secondary breast cancer and heart disease

(Verhoeven et al, 2). Latent effects are associated with increased non-breast-cancer-related

mortality and the majority is caused by cardiovascular complications (Kirby et al, 1). In the

supine position it is difficult to avoid OAR because the left breast is wrapped around the heart

and ipsilateral lung (Veldman et al, 1). Also, in larger breasted woman high-dose regions can

develop because when there is more skin to skin contact there is an increase in scatter radiation

resulting in more skin irritation. Although, modern radiation techniques have decreased the

cardiac and pulmonary doses significantly, when radiation is delivered to the breast in the supine

position the dose to the heart and descending coronary artery (LAD) continue to be an area of

concern (Verhoeven et al, 2).

Breast cancer is often curable and survival rates are high, so patients are at an increased

risk to develop long term effects. New advance treatment techniques are needed to reduce

exposure to OAR (Verhoeven et al, 2). New techniques include supine position using deep

inspiratory breath holds (DIBH) and prone position compared with the standard free breathing
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supine position. The prone position can greatly decrease the dose to OAR and promote better

dose homogeneity and prevent high-dose regions (Veldman et al, 1).

Although there are many advantages in dose distribution, in clinic prone is more difficult

to reproduce on a daily basis, longer treatment times are due to difficult immobilization, and

patient discomfort (Veldman et al, 1). More studies are being conducted to determine

reproducibility through researching set-up errors and respiratory motion (Veldman et al, 1).

Reaction

Only a cohort study was performed (Veldman et al,).

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Works Cited

Kirby, Anna M., Evans, Philip, Helyer, Sarah, Donovan, Ellen, Convery, Helen, Yarnoldet, John. A

Randomized Trial of Supine versus Prone Breast Radiotherapy (SuPr Study): Comparing Set-up

Errors and Respiratory Motion. Radiotherapy and Oncology, vol. 100, no. 2, 2011, pp. 221–226.,

doi:10.1016/j.radonc.2010.11.005.

Veldeman, Liv, Degersem, Werner, Speleer, Bruno, Truyens, Bart, Van Greveling, Annick, Van

DenBroecke, Rudy, DeNeve, Wilfried. Alternated Prone and Supine Whole-Breast Irradiation

Using IMRT: Setup Precision, Respiratory Movement and Treatment Time. International

Journal of Radiation Oncology*Biology*Physics, vol. 82, no. 5, 2012, pp. 2055–2064.,

doi:10.1016/j.ijrobp.2010.10.070.

Verhoeven, Karolien, Sweldens, Caroline, Petillion, Saskia, Laenen, Annouschka, Peeters, Stephanie,

Janssen, Hilde, VanLimbergen, Erik, Weltens, Caroline. Breathing Adapted Radiation Therapy

in Comparison with Prone Position to Reduce the Doses to the Heart, Left Anterior Descending

Coronary Artery, and Contralateral Breast in Whole Breast Radiation Therapy. Practical

Radiation Oncology, vol. 4, no. 2, 2014, pp. 123–129., doi:10.1016/j.prro.2013.07.005.

PMID: 21159397
PMID:21570208
PMID:24890353
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