Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes

Authors

  • Vincent Vakaet a Department of Human Structure and Repair, Ghent University, Gent, Belgium; b Department of Radiation Oncology, Ghent University Hospital, Gent, Belgium
  • Pieter Deseyne c Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  • Renée Bultijnck a Department of Human Structure and Repair, Ghent University, Gent, Belgium
  • Giselle Post a Department of Human Structure and Repair, Ghent University, Gent, Belgium
  • Catharine West d Christie Hospital, University of Manchester, Manchester, UK
  • David Azria e Department of Radiation Oncology, University of Montpellier, Montpellier, France
  • Celine Bourgier e Department of Radiation Oncology, University of Montpellier, Montpellier, France
  • Marie-Pierre Farcy-Jacquet e Department of Radiation Oncology, University of Montpellier, Montpellier, France
  • Barry Rosenstein f Departments of Radiation Oncology and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Sheryl Green f Departments of Radiation Oncology and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Dirk de Ruysscher g Department of Radiation Oncology (Maastro), GROW, Maastricht University Medical Center, Maastricht, The Netherland
  • Elena Sperk h Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
  • Marlon Veldwijk h Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
  • Carsten Herskind h Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; i Radiation Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  • Maria Carmen De Santis i Radiation Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  • Tiziana Rancati j Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  • Tommaso Giandini k Medical Physics Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
  • Jenny Chang-Claude l Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
  • Petra Seibold l Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
  • Maarten Lambrecht m Department of Radiation Oncology, UZ Leuven, Leuven, Belgium
  • Caroline Weltens m Department of Radiation Oncology, UZ Leuven, Leuven, Belgium
  • Hilde Janssens m Department of Radiation Oncology, UZ Leuven, Leuven, Belgium
  • Ana Vega n Instituto de Investigacion Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
  • Maria Begoña Taboada-Valladares n Instituto de Investigacion Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
  • Miguel Elías Aguado-Barrera n Instituto de Investigacion Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
  • Victoria Reyes o Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
  • Manuel Altabas o Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
  • Sara Gutiérrez-Enríquez p Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
  • Christel Monten b Department of Radiation Oncology, Ghent University Hospital, Gent, Belgium
  • Hans Van Hulle q Clinical Research Centre, AZ Sint-Jan, Brugge, Belgium
  • Liv Veldeman a Department of Human Structure and Repair, Ghent University, Gent, Belgium; b Department of Radiation Oncology, Ghent University Hospital, Gent, Belgium

DOI:

https://doi.org/10.1080/0284186X.2023.2240486

Keywords:

Breast cancer, prone position, radiotherapy toxicity, health-related quality of life, dosimetry

Abstract

Objective

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.

Methods

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.

Results

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).

Conclusions

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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Published

2023-09-02

How to Cite

Vakaet, V., Deseyne, P., Bultijnck, R., Post, G., West, C., Azria, D., … Veldeman, L. (2023). Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes. Acta Oncologica, 62(9), 1036–1044. https://doi.org/10.1080/0284186X.2023.2240486

Issue

Vol. 62 No. 9 (2023): Acta Oncologica

Section

Articles