TY - JOUR
T1 - Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data
T2 - dosimetry, acute and two years physician and patient-reported outcomes
AU - Vakaet, Vincent
AU - Deseyne, Pieter
AU - Bultijnck, Renee
AU - Post, Giselle
AU - West, Catharine
AU - Azria, David
AU - Bourgier, Celine
AU - Farcy-Jacquet, Marie-Pierre
AU - Rosenstein, Barry
AU - Green, Sheryl
AU - de Ruysscher, Dirk
AU - Sperk, Elena
AU - Veldwijk, Marlon
AU - Herskind, Carsten
AU - De Santis, Maria Carmen
AU - Rancati, Tiziana
AU - Giandini, Tommaso
AU - Chang-Claude, Jenny
AU - Seibold, Petra
AU - Lambrecht, Maarten
AU - Weltens, Caroline
AU - Janssens, Hilde
AU - Vega, Ana
AU - Taboada-Valladares, Maria Begona
AU - Aguado-Barrera, Miguel Elias
AU - Reyes, Victoria
AU - Altabas, Manuel
AU - Gutierrez-Enriquez, Sara
AU - Monten, Christel
AU - Van Hulle, Hans
AU - Veldeman, Liv
PY - 2023/9/2
Y1 - 2023/9/2
N2 - ObjectiveMost patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcomes, photographic assessment, and dosimetry between both positions using REQUITE data.MethodsREQUITE is an international multi-centre prospective observational study that recruited 2069 breast cancer patients receiving radiotherapy. Data on toxicity, health-related quality of life (HRQoL), and dosimetry were collected, as well as a photographic assessment. A matched case control analysis compared patients treated prone (n = 268) versus supine (n = 493). Exact matching was performed for the use of intensity-modulated radiotherapy, boost, lymph node irradiation, chemotherapy and fractionation, and the nearest neighbour for breast volume. Primary endpoints were dermatitis at the end of radiotherapy, and atrophy and cosmetic outcome by photographic assessment at two years.ResultsAt the last treatment fraction, there was no significant difference in dermatitis (p = .28) or any HRQoL domain, but prone positioning increased the risk of breast oedema (p < .001). At 2 years, patients treated in prone position had less atrophy (p = .01), and higher body image (p < .001), and social functioning (p < .001) scores. The photographic assessment showed no difference in cosmesis at 2 years (p = .22). In prone position, mean heart dose (MHD) was significantly lower for left-sided patients (1.29 Gy vs 2.10 Gy, p < .001) and ipsilateral mean lung dose (MLD) was significantly lower for all patients (2.77 Gy vs 5.89 Gy, p < .001).ConclusionsProne radiotherapy showed lower MLD and MHD compared to supine position, although the risk of developing breast oedema during radiotherapy was higher. At 2 years the photographic assessment showed no difference in the cosmetic outcome, but less atrophy was seen in prone-treated patients and this seems to have a positive influence on the HRQoL domain of body image.
AB - ObjectiveMost patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcomes, photographic assessment, and dosimetry between both positions using REQUITE data.MethodsREQUITE is an international multi-centre prospective observational study that recruited 2069 breast cancer patients receiving radiotherapy. Data on toxicity, health-related quality of life (HRQoL), and dosimetry were collected, as well as a photographic assessment. A matched case control analysis compared patients treated prone (n = 268) versus supine (n = 493). Exact matching was performed for the use of intensity-modulated radiotherapy, boost, lymph node irradiation, chemotherapy and fractionation, and the nearest neighbour for breast volume. Primary endpoints were dermatitis at the end of radiotherapy, and atrophy and cosmetic outcome by photographic assessment at two years.ResultsAt the last treatment fraction, there was no significant difference in dermatitis (p = .28) or any HRQoL domain, but prone positioning increased the risk of breast oedema (p < .001). At 2 years, patients treated in prone position had less atrophy (p = .01), and higher body image (p < .001), and social functioning (p < .001) scores. The photographic assessment showed no difference in cosmesis at 2 years (p = .22). In prone position, mean heart dose (MHD) was significantly lower for left-sided patients (1.29 Gy vs 2.10 Gy, p < .001) and ipsilateral mean lung dose (MLD) was significantly lower for all patients (2.77 Gy vs 5.89 Gy, p < .001).ConclusionsProne radiotherapy showed lower MLD and MHD compared to supine position, although the risk of developing breast oedema during radiotherapy was higher. At 2 years the photographic assessment showed no difference in the cosmetic outcome, but less atrophy was seen in prone-treated patients and this seems to have a positive influence on the HRQoL domain of body image.
KW - Breast cancer
KW - prone position
KW - radiotherapy toxicity
KW - health-related quality of life
KW - dosimetry
KW - >
KW - QUALITY-OF-LIFE
KW - MODULATED RADIATION-THERAPY
KW - RANDOMIZED-TRIAL
KW - EUROPEAN-ORGANIZATION
KW - HEART-DISEASE
KW - WHOLE
KW - IRRADIATION
KW - TOXICITY
KW - LUNG
KW - EXPOSURE
U2 - 10.1080/0284186X.2023.2240486
DO - 10.1080/0284186X.2023.2240486
M3 - Article
C2 - 37548182
SN - 0284-186X
VL - 62
SP - 1036
EP - 1044
JO - Acta Oncologica
JF - Acta Oncologica
IS - 9
ER -