Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-06-23T06:19:41.807Z Has data issue: false hasContentIssue false
  • English
  • Français

A service evaluation of the immobilisation techniques adopted for breast cancer patients with large and/or pendulous breasts, receiving external beam radiotherapy

Published online by Cambridge University Press:  13 January 2020

Lisa Montgomery ,
Terri Flood  and
Paul Shepherd Open the ORCID record for Paul Shepherd [Opens in a new window]
Lisa Montgomery
Affiliation:
Belfast Health and Social Care Trust, Belfast City Hospital, BT9 7AB Northern Ireland, UK
Terri Flood
Affiliation:
School of Health Sciences, Ulster University, Jordanstown Campus, Newtownabbey, County Antrim BT37 0QB, Northern Ireland, UK
Paul Shepherd*
Affiliation:
School of Health Sciences, Ulster University, Jordanstown Campus, Newtownabbey, County Antrim BT37 0QB, Northern Ireland, UK
*
Author for correspondence: Paul Shepherd, School of Health Sciences, Ulster University, Jordanstown Campus, Newtownabbey, County Antrim, BT37 0QB, UK. E-mail: PH.Shepherd@ulster.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Breast cancer patients referred for external beam radiotherapy and who have large and/or pendulous breasts can present positioning and immobilisation challenges. Deep infra-mammary and/or lateral wrap skin folds can occur that can lead to unwanted radiation-induced skin toxicity. The purpose of the study was to evaluate the immobilisation techniques adopted for this subgroup of patients in order to inform best practice.

Method:

A survey aimed to identify the current clinical practice in radiotherapy centres throughout the United Kingdom and Ireland was undertaken. The email survey was distributed with support of the Radiotherapy Services Managers group.

Results:

Twenty-six of the 74 radiotherapy centres responded to the survey. Responses demonstrated that supine positioning with or without additional immobilisation was preferable. Of the eight different immobilisation techniques identified, patients positioned supine on a breast board wearing a bra was the most common. Only two of the centres reported using a prone technique.

Conclusions:

Immobilisation and reproducibility are key for successful external beam radiotherapy particularly when advanced treatment techniques are being employed. No single technique gained widespread acceptance as the optimum for the effective immobilisation of patients with large and/or pendulous breasts. Further evaluative research in the form of a multi-centre trial is warranted in order to clearly establish the most effective immobilisation methods/devices for this ever expanding, subgroup of cancer patients.

Keywords

external beam radiotherapyimmobilisationinfra-mammarylarge pendulous breastskin fold
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 4 , December 2020 , pp. 341 - 346
Check for updates
Copyright
© The Author(s) 2020. Published by Cambridge University Press.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chen, J L, Cheng, J C, Kuo, S H, Chan, H M, Huang, Y S, Chen, Y H Prone breast forward intensity-modulated radiotherapy for Asian women with early left breast cancer: factors for cardiac sparing and clinical outcomes. J Radiat Res 2013; 54 (5): 899–908.CrossRefGoogle ScholarPubMed
Ferrari, A, Ivaldi, G, Leonard, M C, Rondi, E, Orecchia, R Prone breast radiotherapy in a patient with early stage breast cancer and a large pendulous breast. Tumori 2009; 95: 394–397.CrossRefGoogle Scholar
Krengli, M, Masini, L, Caltavuturo, T et al. Prone versus supine position for adjuvant breast radiotherapy: a prospective study in patients with pendulous breasts. Radiat Oncol 2013; 8 (1): 232.CrossRefGoogle ScholarPubMed
Morrow, N V, Stepaniak, C, White, J, Wilson, J F, Li, X A Intra-and interfractional variations for prone breast irradiation: an indication for image-guided radiotherapy. Int J Radiat Oncol Biol Phys 2007; 69 (3): 910–917.CrossRefGoogle ScholarPubMed
Mulliez, T, Gulyban, A, Vercauteren, T et al. Setup accuracy for prone and supine whole breast irradiation. Strahlenther Onkol. 2016; 192 (4): 254–259.CrossRefGoogle ScholarPubMed
Bartlett, F R, Colgan, R M, Donovan, E M et al. The UK HeartSpare Study (Stage IB): randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery. Radiot Oncol 2015; 114 (1): 66–72.CrossRefGoogle ScholarPubMed
Jain, P, Marchant, T, Green, M et al. Inter-fraction motion and dosimetric consequences during breast intensity-modulated radiotherapy (IMRT). Radiot Oncol 2009; 90 (1): 93–98.CrossRefGoogle Scholar
Buijsen, J, Jager, J J, Bovendeerd, J et al. Prone breast irradiation for pendulous breasts. Radiot Oncol 2007; 82 (3): 337–340.CrossRefGoogle ScholarPubMed
Bergom, C, Kelly, T, Morrow, N et al. Prone whole-breast irradiation using three-dimensional conformal radiotherapy in women undergoing breast conservation for early disease yields high rates of excellent to good cosmetic outcomes in patients with large and/or pendulous breasts. Int J Radiat Oncol Biol Phys 2012; 83 (3): 821–828.CrossRefGoogle ScholarPubMed
Lymberis, S C, Dewyngaert, J K, Parhar, P et al. Prospective assessment of optimal individual position (prone versus supine) for breast radiotherapy: volumetric and dosimetric correlations in 100 patients. Int J Radiat Oncol Biol Phys 2012; 84 (4): 902–909.CrossRefGoogle ScholarPubMed
DeWyngaert, J K, Jozsef, G, Mitchell, J, et al. Accelerated intensity-modulated radiotherapy to breast in prone position: dosimetric results. Int J Radiat Oncol Biol Phys 2007; 68: 1251–1259.CrossRefGoogle ScholarPubMed
Merchant, T E, McCormick, B Prone position breast irradiation. Int J Radiat Oncol Biol Phys 1994; 30: 197–203.CrossRefGoogle ScholarPubMed
Verhoeven, K, Sweldens, C, Petillion, S et al.. Breathing adapted radiation therapy in comparison with prone position to reduce the doses to the heart, left anterior descending coronary artery, and contralateral breast in whole breast radiation therapy. Practical Radiat Oncol 2014; 4 (2): 123–129.CrossRefGoogle ScholarPubMed
Stegman, L D, Beal, K P, Hunt, M A, Fornier, M N, McCormick, B Long-term clinical outcomes of whole-breast irradiation delivered in the prone position. Int J Radiat Oncol Biol Phys 2007; 68 (1): 73–81.CrossRefGoogle ScholarPubMed
Kirby, A M, Evans, P M, Helyer, S J, Donovan, E M, Convery, H M, Yarnold, J R A randomised trial of supine versus prone breast radiotherapy (SuPr study): comparing set-up errors and respiratory motion. Radiot Oncol 2011; 100 (2): 221–226.CrossRefGoogle ScholarPubMed
Varga, Z, Hideghéty, K, Mező, T, Nikolényi, A, Thurzó, L, Kahán, Z Individual positioning: a comparative study of adjuvant breast radiotherapy in the prone versus supine position. Int J Radiat Oncol Biol Phys 2009; 75 (1): 94–100.CrossRefGoogle ScholarPubMed
Offerman, S, Lamba, M, Lavigne, R Effect of breast volume on treatment reproducibility on a tomotherapy unit in the treatment of breast cancer. Int J Radiat Oncol Biol Phys 2011; 80 (2): 417–421.CrossRefGoogle ScholarPubMed
Arenas, M, Hernández, V, Farrús, B et al. Do breast cups improve breast cancer dosimetry? A comparative study for patients with large or pendulous breasts. Acta Oncol 2014; 53 (6): 795–801.CrossRefGoogle ScholarPubMed
Jozsef, G, DeWyngaert, K, Becker, S J, Lymberis, S, Formenti, S Prospective study of cone-beam computed tomography image-guided radiotherapy for prone accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2011; 81 (2): 568–574.CrossRefGoogle ScholarPubMed
Fatunase, T, Wang, Z, Yoo, S et al. Assessment of the residual error in soft tissue setup in patients undergoing partial breast irradiation: results of a prospective study using cone-beam computed tomography. Int J Radiat Oncol Biol Phys. 2008; 70 (4): 1025–1034.Google ScholarPubMed