TY  - JOUR
AU  - Vakaet, Vincent
AU  - Deseyne, Pieter
AU  - Bultijnck, Renée
AU  - Post, Giselle
AU  - West, Catharine
AU  - Azria, David
AU  - Bourgier, Celine
AU  - Farcy-Jacquet, Marie-Pierre
AU  - Rosenstein, Barry
AU  - Green, Sheryl
AU  - de Ruysscher, Dirk
AU  - Sperk, Elena
AU  - Veldwijk, Marlon
AU  - Herskind, Carsten
AU  - De Santis, Maria Carmen
AU  - Rancati, Tiziana
AU  - Giandini, Tommaso
AU  - Chang-Claude, Jenny
AU  - Seibold, Petra
AU  - Lambrecht, Maarten
AU  - Weltens, Caroline
AU  - Janssens, Hilde
AU  - Vega, Ana
AU  - Taboada-Valladares, Maria Begoña
AU  - Aguado-Barrera, Miguel Elías
AU  - Reyes, Victoria
AU  - Altabas, Manuel
AU  - Gutiérrez-Enríquez, Sara
AU  - Monten, Christel
AU  - Van Hulle, Hans
AU  - Veldeman, Liv
TI  - Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes.
JO  - Acta oncologica
VL  - 62
IS  - 9
SN  - 0284-186X
CY  - Abingdon
PB  - Taylor & Francis Group
M1  - DKFZ-2023-01596
SP  - 1036-1044
PY  - 2023
N1  - 2023 Sep;62(9):1036-1044
AB  - 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.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.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).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.
KW  - Breast cancer (Other)
KW  - dosimetry (Other)
KW  - health-related quality of life (Other)
KW  - prone position (Other)
KW  - radiotherapy toxicity (Other)
LB  - PUB:(DE-HGF)16
C6  - pmid:37548182
DO  - DOI:10.1080/0284186X.2023.2240486
UR  - https://inrepo02.dkfz.de/record/278339
ER  -