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Title: Prospective Assessment of Optimal Individual Position (Prone Versus Supine) for Breast Radiotherapy: Volumetric and Dosimetric Correlations in 100 Patients

Abstract

Purpose: Damage to heart and lung from breast radiotherapy is associated with increased cardiovascular mortality and lung cancer development. We conducted a prospective study to evaluate which position is best to spare lung and heart from radiotherapy exposure. Methods and Materials: One hundred consecutive Stage 0-IIA breast cancer patients consented to participate in a research trial that required two computed tomography simulation scans for planning both supine and prone positions. The optimal position was defined as that which best covered the contoured breast and tumor bed while it minimized critical organ irradiation, as quantified by the in-field heart and lung volume. The trial was designed to plan the first 100 patients in each position to study correlations between in-field volumes of organs at risk and dose. Results: Fifty-three left and 47 right breast cancer patients were consecutively accrued to the trial. In all patients, the prone position was optimal for sparing lung volume compared to the supine setup (mean lung volume reduction was 93.5 cc for right and 103.6 cc for left breast cancer patients). In 46/53 (87%) left breast cancer patients best treated prone, in-field heart volume was reduced by a mean of 12 cc and by 1.8 ccmore » for the other 7/53 (13%) patients best treated supine. As predicted, supine-prone differences in in-field volume and mean dose of heart and lung were highly correlated (Spearman's correlation coefficient for left breast cancer patients was 0.90 for heart and 0.94 for lung and 0.92 for right breast cancer patients for lung). Conclusions: Prone setup reduced the amount of irradiated lung in all patients and reduced the amount of heart volume irradiated in 87% of left breast cancer patients. In-field organ volume is a valid surrogate for predicting dose; the trial continued to the planned target of 400.« less

Authors:
; ; ; ; ;  [1];  [2];  [3]; ;  [4];  [2];  [3];  [1]
  1. Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States)
  2. Division of Biostatistics, New York University School of Medicine and Langone Medical Center, New York, New York (United States)
  3. (United States)
  4. Department of Surgery, New York University School of Medicine and Langone Medical Center, New York, New York (United States)
Publication Date:
OSTI Identifier:
22149622
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 4; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COMPUTERIZED TOMOGRAPHY; HEALTH HAZARDS; HEART; IRRADIATION; LUNGS; MAMMARY GLANDS; MORTALITY; NEOPLASMS; PATIENTS; PLANNING; RADIATION DOSES; RADIATION INJURIES; RADIOTHERAPY; SIMULATION

Citation Formats

Lymberis, Stella C., Wyngaert, John Keith de, Parhar, Preeti, Chhabra, Arpit M., Fenton-Kerimian, Maria, Chang Jengwha, Hochman, Tsivia, Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York, Guth, Amber, Roses, Daniel, Goldberg, Judith D., Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York, and Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org. Prospective Assessment of Optimal Individual Position (Prone Versus Supine) for Breast Radiotherapy: Volumetric and Dosimetric Correlations in 100 Patients. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.01.040.
Lymberis, Stella C., Wyngaert, John Keith de, Parhar, Preeti, Chhabra, Arpit M., Fenton-Kerimian, Maria, Chang Jengwha, Hochman, Tsivia, Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York, Guth, Amber, Roses, Daniel, Goldberg, Judith D., Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York, & Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org. Prospective Assessment of Optimal Individual Position (Prone Versus Supine) for Breast Radiotherapy: Volumetric and Dosimetric Correlations in 100 Patients. United States. doi:10.1016/J.IJROBP.2012.01.040.
Lymberis, Stella C., Wyngaert, John Keith de, Parhar, Preeti, Chhabra, Arpit M., Fenton-Kerimian, Maria, Chang Jengwha, Hochman, Tsivia, Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York, Guth, Amber, Roses, Daniel, Goldberg, Judith D., Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York, and Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org. Thu . "Prospective Assessment of Optimal Individual Position (Prone Versus Supine) for Breast Radiotherapy: Volumetric and Dosimetric Correlations in 100 Patients". United States. doi:10.1016/J.IJROBP.2012.01.040.
@article{osti_22149622,
title = {Prospective Assessment of Optimal Individual Position (Prone Versus Supine) for Breast Radiotherapy: Volumetric and Dosimetric Correlations in 100 Patients},
author = {Lymberis, Stella C. and Wyngaert, John Keith de and Parhar, Preeti and Chhabra, Arpit M. and Fenton-Kerimian, Maria and Chang Jengwha and Hochman, Tsivia and Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York and Guth, Amber and Roses, Daniel and Goldberg, Judith D. and Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York and Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org},
abstractNote = {Purpose: Damage to heart and lung from breast radiotherapy is associated with increased cardiovascular mortality and lung cancer development. We conducted a prospective study to evaluate which position is best to spare lung and heart from radiotherapy exposure. Methods and Materials: One hundred consecutive Stage 0-IIA breast cancer patients consented to participate in a research trial that required two computed tomography simulation scans for planning both supine and prone positions. The optimal position was defined as that which best covered the contoured breast and tumor bed while it minimized critical organ irradiation, as quantified by the in-field heart and lung volume. The trial was designed to plan the first 100 patients in each position to study correlations between in-field volumes of organs at risk and dose. Results: Fifty-three left and 47 right breast cancer patients were consecutively accrued to the trial. In all patients, the prone position was optimal for sparing lung volume compared to the supine setup (mean lung volume reduction was 93.5 cc for right and 103.6 cc for left breast cancer patients). In 46/53 (87%) left breast cancer patients best treated prone, in-field heart volume was reduced by a mean of 12 cc and by 1.8 cc for the other 7/53 (13%) patients best treated supine. As predicted, supine-prone differences in in-field volume and mean dose of heart and lung were highly correlated (Spearman's correlation coefficient for left breast cancer patients was 0.90 for heart and 0.94 for lung and 0.92 for right breast cancer patients for lung). Conclusions: Prone setup reduced the amount of irradiated lung in all patients and reduced the amount of heart volume irradiated in 87% of left breast cancer patients. In-field organ volume is a valid surrogate for predicting dose; the trial continued to the planned target of 400.},
doi = {10.1016/J.IJROBP.2012.01.040},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}