1. Potential benefits of crawl position for prone radiation therapy in breast cancer
- Author
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Werner De Gersem, Bruno Speleers, Jan Detand, Christel Monten, Tom Vercauteren, Wilfried De Neve, Leen Paelinck, Liv Veldeman, Tom Van Hoof, Joris Van de Velde, Bert Boute, and Annick Van Greveling
- Subjects
medicine.medical_specialty ,Supine position ,prone radiotherapy ,medicine.medical_treatment ,Planning target volume ,Breast Neoplasms ,HEART-DISEASE ,Dose distribution ,Pain, Procedural ,Patient Positioning ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,LUNG-CANCER ,0302 clinical medicine ,Breast cancer ,Xxxx ,breast cancer ,Medicine and Health Sciences ,medicine ,Prone Position ,Radiation Oncology Physics ,Humans ,Radiology, Nuclear Medicine and imaging ,Instrumentation ,Lymph node ,RISK ,crawl position ,Radiation ,Lymphatic Irradiation ,business.industry ,Radiotherapy Planning, Computer-Assisted ,TRIAL COMPARING PRONE ,WOMEN ,Radiotherapy Dosage ,medicine.disease ,IRRADIATION ,Surgery ,Radiation therapy ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Coronal plane ,Female ,Lymph ,Radiology ,Lymph Nodes ,business ,RADIOTHERAPY - Abstract
Purpose To investigate crawl position with the arm at the treated side alongside the body and at the opposite side above the head for prone treatment in patients requiring breast and regional lymph node irradiation. Methods Patient support devices for crawl position were built for CT simulation and treatment. An asymmetric fork design resulted from an iterative process of prototype construction and testing. The fork's large horn supports the hemi-thorax, shoulder, and elevated arm at the nontreated side and the head. The short, narrow horn supports the arm at the treated side. Between both horns, the treated breast and its regional lymph nodes are exposed. Endpoints were pain, comfort, set-up precision, beam access to the breast and lymph nodes, and plan dose metrics. Pain and comfort were tested by volunteers (n = 9); set-up precision, beam access, and plan dose metrics were tested by means of a patient study (n = 10). The AIO™ (Orfit, Wijnegem, Belgium) prone breastboard (AIO™) was used as a reference regarding comfort and set-up precision. Results Pain at the sternum, the ipsilateral shoulder, upper arm, and neck was lower in crawl position than with bilateral arm elevation on AIO™. Comfort and set-up precision were better on the crawl prototype than on AIO™. In crawl position, beam directions in the coronal and near-sagittal planes have access to the breast or regional lymph nodes without traversing device components. Plan comparison between supine and crawl positions showed better dose homogeneity for the breast and lymph node targets and dose reductions to all organs at risk for crawl position. Conclusions Radiation therapy for breast and regional lymph nodes in crawl position is feasible. Good comfort and set-up precision were demonstrated. Planning results support the hypothesis that breast and regional lymph nodes can be treated in crawl position with less dose to organs at risk and equal or better dose distribution in the target volumes than in supine position. The crawl technique is a candidate methodology for further investigation for patients requiring breast and regional lymph node irradiation. more...
- Published
- 2017