Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes
Most 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, photogra...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
07 Aug 2023
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| In: |
Acta oncologica
Year: 2023, Volume: 62, Issue: 9, Pages: 1036-1044 |
| ISSN: | 1651-226X |
| DOI: | 10.1080/0284186X.2023.2240486 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1080/0284186X.2023.2240486 Verlag, lizenzpflichtig, Volltext: https://www.tandfonline.com/doi/full/10.1080/0284186X.2023.2240486 
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| Author Notes: | Vincent Vakaet, Pieter Deseyne, Renée Bultijnck, Giselle Post, Catharine West, David Azria, Celine Bourgier, Marie-Pierre Farcy-Jacquet, Barry Rosenstein, Sheryl Green, Dirk de Ruysscher, Elena Sperk, Marlon Veldwijk, Carsten Herskind, Maria Carmen De Santis, Tiziana Rancati, Tommaso Giandini, Jenny Chang-Claude, Petra Seibold, Maarten Lambrecht, Caroline Weltens, Hilde Janssens, Ana Vega, Maria Begoña Taboada-Valladares, Miguel Elías Aguado-Barrera, Victoria Reyes, Manuel Altabas, Sara Gutiérrez-Enríquez, Christel Monten, Hans Van Hulle and Liv Veldeman |
| Summary: | Most 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. REQUITE 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. At 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). Prone 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. |
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| Item Description: | Gesehen am 18.07.2024 |
| Physical Description: | Online Resource |
| ISSN: | 1651-226X |
| DOI: | 10.1080/0284186X.2023.2240486 |