Prone Breast Irradiation

  • Multiple techniques have been used to aid in cardiac sparing including:
    • Assisted breathing control
    • Accelerated partial breast irradiation
    • Intensity-modulated radiation therapy
    • Prone breast irradiation
  • A recent study from Mulliez et al:
    • Found that prone technique in conjunction with respiratory gating was associated with a:
      • Reduction in mean heart dose as well as dose to the left anterior descending coronary artery
  • At this time:
    • There are limited data regarding long-term cardiac outcomes (eg, myocardial infarctions) with any cardiac sparing technique:
      • Due to the length of follow-up required
  • Outcomes with prone breast irradiation have demonstrated:
    • Low rates of local recurrence
    • Excellent cosmetic outcomes
    • No suggestion of higher rates of skin toxicity
    • Lower doses to the lungs and heart
    • Nsuggestion of higher rates of pneumonitis
  • References:
  • Mulliez T, Speleers B, Mahjoubi K, et al. Prone left-sided whole-breast irradiation: significant heart dose reduction using end-inspiratory versus end-expiratory gating. Cancer Radiother. 2014;18:672-677.
  • Mulliez T, Veldeman L, Speleers B, et al. Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation. Radiother Oncol. 2015;114:79-84.
  • Osa EO, DeWyngaert K, Roses D, et al. Prone breast intensity modulated radiation therapy: 5-year results. Int J Radiat Oncol Biol Phys. 2014;89:899-906.
  • Shah C, Badiyan S, Berry S, et al. Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy. Radiother Oncol. 2014;112:9-16.

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