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@ARTICLE{Vakaet:278339,
      author       = {V. Vakaet and P. Deseyne and R. Bultijnck and G. Post and
                      C. West and D. Azria and C. Bourgier and M.-P. Farcy-Jacquet
                      and B. Rosenstein and S. Green and D. de Ruysscher and E.
                      Sperk and M. Veldwijk and C. Herskind and M. C. De Santis
                      and T. Rancati and T. Giandini and J. Chang-Claude$^*$ and
                      P. Seibold$^*$ and M. Lambrecht and C. Weltens and H.
                      Janssens and A. Vega and M. B. Taboada-Valladares and M. E.
                      Aguado-Barrera and V. Reyes and M. Altabas and S.
                      Gutiérrez-Enríquez and C. Monten and H. Van Hulle and L.
                      Veldeman},
      title        = {{C}omparison of prone and supine positioning for breast
                      cancer radiotherapy using {REQUITE} data: dosimetry, acute
                      and two years physician and patient-reported outcomes.},
      journal      = {Acta oncologica},
      volume       = {62},
      number       = {9},
      issn         = {0284-186X},
      address      = {Abingdon},
      publisher    = {Taylor $\&$ Francis Group},
      reportid     = {DKFZ-2023-01596},
      pages        = {1036-1044},
      year         = {2023},
      note         = {2023 Sep;62(9):1036-1044},
      abstract     = {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.},
      keywords     = {Breast cancer (Other) / dosimetry (Other) / health-related
                      quality of life (Other) / prone position (Other) /
                      radiotherapy toxicity (Other)},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37548182},
      doi          = {10.1080/0284186X.2023.2240486},
      url          = {https://inrepo02.dkfz.de/record/278339},
}